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i LIBiiAiiY OF COXGilKSS. 






a UXITED STATES OF A.MKUICA. S 



FIBEO-EEONCHITIS 



AND 



EHEUMATIC PNEUMONIA 



ERRATA. 



Page 30, line 10 from bottom, for "the blood" read "blue blood/' 

"' " abscessiao-" read "obsessing." 
" "5iv." read "5iv." 
" "microscopic'^ read "double." 
"' "9j." read "Oj." 
" "empyema" read "emphysema." 
" "where there is no reason" read 
. "where there is reason." 
" 136, " 14 " " " "under &c." read "render their em- 
ployment advantageous or otherwise." 



" 41, 




15 




u 


" 73, 




12 




a 


" 77, 




8 




top 


" 105, 




8 




u 


" 106, 




11 




u 


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7 




bott( 



ON THE 



a 



ETIOLOGY, PATHOLOGY 



TREATMENT 



FIBRO-BRONCHITIS 



RHEUMATIC PNEUMONIA. 



BY 



THOMAS H. BUCKLER, M. D., 

FORMEKLY PHY3ICIA>f TO TEE BALTIMOKE ALMSHOUSE IXFIRMARY. 







PHILADELPHIA: 
BLANC HARD AND LEA. 

1853. 




Entered according to tlie Act of Congress, in the year 1853, by 
BLANCHARD AND LEA, 

in the Office of the Clerk of the District Court of the United States in and for 
the Eastern District of Pennsylvania. 



PHILADELPHIA : 
T. K. AND P. G. COLLIXS, PEINTEES. 



V 



THE 

WHICH HAD BEEN DEDICATED TO THE LATE 

PROFESSOE POWER, 

AS A SMALL PROOF OF THE RESPECT ENTERTAINED BOTH FOR HIS 

PURITY OF CHARACTER AND HIGH MEDICAL SCHOLARSHIP, 

IS NOW 

AFFECTIONATELY INSCRIBED 

TO 

HIS MEMOEY. 



PREFACE. 



The etiology and pathological semeiology of diseases 
of the chest having been thoroughly examined and 
elucidated by so many profound observers, it may seem 
proper to apologize for entertaining the subject anew. 
and, especially, for instituting an inquiry into a disease 
so common as bronchial catarrh, and which generally 
occurs in so mild a form, that there is a proneness to 
regard it as far simpler and better understood than 
almost any other affection. 

Trusting, however, that a mere gleaner may be per- 
mitted in a field from which the rich harvest has 
already been gathered, the following observations are 
advanced, with the assurance that, had they possessed 
an interest barely scientific in its character, the time 
and attention of the reader would have been spared, 
and that they are only brought forward now because it 
is believed that they involve truths of immense import- 
ance in a practical and therapeutic point of view. 

A knowledge, moreover, of fibrous bronchitis serves 
to explain several points in thoracic pathology, which 
hitherto, involved in much obscurity, have led to con- 
troversy between the best observers. 



FIBROUS OR RHEUMATIC BRONCHITIS 



RHEUMATIC PNEUMONIA.' 



The leading object of this volume is to point out, as 
clearly as possible, the distinctive characters of fibrous 
or rheumatic inflammation of the bronchial tubes, and 
at the same time to show the differential diagnosis be- 
tween it and ordinary catarrh ; the word rheumatic has 
therefore been affixed to the term bronchitis, for the 
purpose of showing at the outset that it is intended to 
treat of a distinct affection, which, for want of proper 
anatomical accuracy as to its true seat, has been most 
singularly confounded with inflammation of the mucous 
membrane of the bronchi. 

The next object is to show that there exists a form of 
pneumonia wihch is never idiopathic, but occurs as a 

* The reader has a right to know that this Dissertation comes before 
him under the cloud of being a rejected address, it having already been 
subjected to the consideration of the Committee of the American Medical 
Association on Voluntary Communications, for 1853. If, however, the 
author's observations shall be verified by others, they must prove valua- 
ble to the profession, since they not only point out a disease never before 
described, and show the differential diagnosis between it and other affec- 
tions with which it may be confounded, but serve, at the same time, to 
explain many minor points of pathology. 

2 



18 FIBROUS OR RHEUMATIC BRONCHITIS 

secondary lesion, and is always symptomatic of, and 
directly dependent on, pre-existing fibrous bronchitis. 
It is farther intended to point out the relations which 
the foregoing pathological conditions bear to general 
rheumatism and to rheumatic endocarditis, and to show 
that ordinary pneumonia, simple mucous catarrh, and 
fibrous bronchitis, with rheumatic pneumonia, often 
happen in the same lung as distinct, but still contem- 
poraneous and concurrent, affections, and that w^here 
this is the case, therapeutic attention to the rheumatic 
element is often of vital importance to the safety of the 
patient. 

According to the present arrangement, all medical 
writers admit the undisputed existence of three idio- 
pathic or symptomatic affections of the lungs — pleuritis, 
pneumonia, and pulmonary catarrh or bronchitis. Now, 
the word pleuritis has direct reference to the anatomical 
seat of the inflammation. The term pneumonia is less 
expressive ; for how comprehensive is the definition of 
this disease, "inflammatory engorgement of some por- 
tion of the pulmonary parenchyma." The word bron- 
chitis, and its definition, " mfiammation of the mucous 
membrane of the hronchial tubes,'' would be equally 
significant, and just as expressive as the foregoing, pro- 
vided the air-tubes were composed of nothing but a 
mucous membrane ; but every one knows that between 
this mucous membrane and the parenchyma of the lungs 
are the hronchial tubes jproper, camjposed entirely, with the 
exception of some few muscular filaments, of fibrous 
tissue and cartilaginous rings. 

It is of disease seated in this fibro-cartilaginous tissue, 
or the bronchial tubes proper, and not of inflammation 
of their investing mucous membrane, or ordinary catarrh, 
that this paper proposes to treat. 

Not very many years ago, all forms of inflammation 



AND RHEUMATIC PNEUMONIA. 19 

of the eye were classed and treated as ^^oplithalmia," 
without regard to the particular tissue laboring under 
the inflammatory process ; but more recent and accurate 
observers have clearly pointed out the differential diag- 
nosis between the various forms of inflammation, as they 
occur in the different and distinct tunics of the eye. The 
result of this is, that in place of the old classification — 
ophthalmia membranarum, purulenta, tarsi, chronica, 
&C.5 and their synonymes — we have now a more accu- 
rate and concise arrangement, based upon the particular 
character or anatomical seat of the inflammation. And 
hence, under the new and more scientific classification, 
we have "conjunctivitis, sclerotitis, keratitis, iritis," &c. 
&c., all of which diseases are entirely distinct as to their 
pathology, etiology, and treatment. 

It is very remarkable that the differential diagnosis 
between mucous and fibrous inflammation of the bronchi 
should have remained without elucidation until this time, 
particularly when it is remembered that the relation 
which these two tissues bear to each other is so like that 
of the two similar tunics of the eye, the sclerotica and 
conjunctiva. Probably the reason of this neglect is, that 
fibrous bronchitis is so often complicated with mucous 
catarrh and pneumonia. 

Now, instead of arranging the forms of bronchitis or 
pulmonary catarrh under the heads of "pituitous, dry 
suffocative, catarrhus senilis, peripneumonia notha, 
chronic catarrh," &c. &c., the following more simple 
classification is hesitatingly proposed : — 

' Mucous — Frequently both idiopa- 
thic and symptomatic. 
. Fibrous or rheumatic— Generally . Acute, subacute, 



idiopathic; often symptomatic. 
Fibrous or gouty — Never idiopa- 
thic; rarely symptomatic. 



and chronic. 



20 FIBROUS OR RHEUMATIC BRONCHITIS 

Symptomatic mucous bronchitis, in the foregoing table, 
has reference exclusively to that form of the disease which 
depends upon previous structural alterations of the pul- 
monary tissues. To this classification might be added 
those forms of catarrh originating from specific poisons, 
and attending variola, rubeola, or the more passive forms 
of vascular congestions which accompany adynamic 
fevers. Convulsive catarrh — hooping-cough — owing its 
origin to a specific irritation in the nervous organization 
of the bronchial surfaces, ought properly to be classed 
amongst the neuroses. It might be well, in view of the 
various forms of mucous inflammations and congestions, 
to adhere to the term catarrh as expressive of inflam- 
mation of the mucous membrane of the air-tubes, and, 
at the same time, restrict the signification of bronchitis 
to inflammation of the bronchial tubes proper. The 
terms muco-bronchitis and fibro-bronchitis may, however, 
be better, simply because they are clear, and, at the same 
time, concise. As significant of the engorgement of the 
pulmonary parenchyma, depending on pre-existing fibrous 
bronchitis, the terms rheumatic or hroncJio-pnemnonia may 
be found more concise and expressive than iDueumonia 
notlia. 

It cannot be shown that our knowledge of either the 
etiology, pathology, or treatment of bronchitis has im- 
proved at all since the observations of Laennec, whose 
Avork furnishes at this day the best systematic arrange- 
ment of the diseases treated of under the head of catarrh. 
It is of some interest, therefore, to refer to remarks of 
this great pioneer in diseases of the chest, who is more 
remarkable than any other medical writer, both for 
having taken hold of a great idea, wide in its applica- 
tion, and for having brought it out into the full and 
perfect daylight of discovery, so as to render its applica- 
tion, in its ultimate and varied details, almost perfect in 



AND RHEUMATIC PNEUMONIA. 21 

Ills own day. Most medical authors who have w^ritten 
since Laennec, speak of bronchitis as if it were a disease 
of which they had the most full and perfect knowledge. 
They write about it as if its etiology, pathology, diag- 
nosis, and treatment, were complete in all their details. 

But what says Laennec, in the very outset of his trea- 
tise on bronchitis? Loviug light rather than darkness, 
and preferring truth to mere dogmatic assertion, he 
writes: ^"Pulmonary catarrh (I quote from Herbert's 
edition) is incontestably one of the most frequent of dis- 
eases ; few persons pass a year without an attack. Yet 
it is perhaps less understood than any disease of rare 
occurrence. * * * Even the nature of catarrh may still 
be a matter of doubt." Again he says, speaking of the 
pathology of bronchitis (p. 61) : " The extent and inten- 
sity of the redness do not bear a uniform proportion to 
the violence of the inflammation, the amount of the 
expectoration, and the acute character of the disease. 
* * * In very acute idiopathic catarrh, the bronchial 
mucous membrane presents traces of inflammation in 
some points only." And again, commenting on the four- 
teenth and sixteenth observations of Andral, Laennec 
says : " In both, the bronchi were extremely pale. In 
neither was there any other cause of disease or death 
observed; so true is it, that besides the light pathological 
anatomy is capable of throwing on these cases — and it 
is unquestionably strong — we must seek for other light 
of an entirely different kind." 

Speaking of the viscid character of the sputa, in dry 
catarrh, he farther says : " Art possesses resources which, 
though not indeed infallible, are at least often successful 
in diminishing this viscosity, and rendering the sputa 
more liquid. This assertion, which will perhaps appear 
to be founded on the antiquated humoral hypothesis, 
certainly neither belongs to myself nor the present time. 



22 FIBROUS OR RHEUMATIC BRONCHITIS 

* * * I employ it as an algebraic x to examine certain 
properties of a cause of disease (a thing that, from its 
nature, may very properly be regarded as on unknown 
quantity), in order, if possible, to succeed in evolving it 
from the system. Otherwise, I attach no importance to 
it; but I can affirm that I have procured great and 
lasting relief in many old and severe cases of dry catarrh, 
by the exhibition of medicines vrhich the humoral and 
chemical physicians for the last three centuries con- 
sidered efficacious in correcting the viscidity of the hu- 
mors." 

That there are more nostrums advertised for the cure 
of bronchitis than for any other affection, is one of the 
best popular evidences we can have that catarrh is but 
very imperfectly understood. As medicine becomes more 
exact and certain, empiricisms will vanish ; for it is gene- 
rally true that patent specifics are most largely recom- 
mended for those diseases which are least perfectly 
understood. 

But, to return. If these significant suggestions of 
Laennec are to be attributed merely to his timidity, or 
to the mists which may have obscured his intellectual 
horizon, and retarded his progress in the path of truth, 
then have the more recent writers aided not only in 
rendering our understanding of this important subject 
more lucid, but also in separating truth from doubt, and 
thereby advancing the sum of positive knowledge. But 
if, on the contrary, there is any meaning in these doubts 
and warnings, which Laennec has so clearly expressed, 
then our knowledge of this important disease has, in the 
hands of more recent observers, retrograded, instead of 
advancing. 

Every one of us has noticed that in rheumatic sclero- 
titis the visible si2:ns of inflammation, even during' life, 
are very trivial, compared with the oftem extreme inten- 



AND RHEUMATIC PNEUMONIA. 23 

sity of the symptoms which accompany it ; and if in 
this affection, as in bronchitis, we were compelled to rely 
on post-mortem observations alone, the entity of sclerotitis 
could hardly be recognized, and we would often look in 
vain for the vascular congestions, the cinnamon-colored 
zone, and the coffee-colored spots, which are so well 
marked before death. A sclerotitis, which had been 
extremely well marked during life in the eye of a man 
who died at the Baltimore Almshouse, of acute pneu- 
monia, could with difficulty be recognized an hour after 
death. 

It does not appear that any medical writer, ancient or 
modern, has noticed the existence of any such disease 
as acute, subacute, chronic idiopathic, or symptomatic 
fibrous bronchitis, and yet it will be shown that this 
affection is an entity as well marked as any other ex- 
istence, and that it may be recognized by signs as clear 
and well defined as those which indicate a pleurisy or 
a pericarditis. 

The attention of the writer was first called particu- 
larly to the occasionally intractable and fatal character 
of catarrh, whilst attending, in the spring of 1842, a 
patient who labored under a local bronchitis, confined 
entirely to the lower lobe of the right lung. The 
subject of this attack was a lady, aged about forty, 
who went during a cold spell of weather to reside at a 
country-house, the apartments of which had been closed 
during the winter, and were not sufficiently ventilated 
or warmed for the safe reception of occupants. Sub- 
jected to this exposure, she took cold ; the attack was 
ushered in with a slight chill, followed by unusual febrile 
disturbance and much flushing of the face, her com- 
plexion in health being rather pale. 

ThiS/lady came under treatment on the second day of 
the attack, when the most painful symptom was a severe 



24 FIBROUS OR RHEUMATIC BRONCHITIS 

headache, rendered more distressing by an almost con- 
stant dry cough ; the respiration was hurried, and the 
pulse frequent, but there was nothing unusual about the 
chest, except a faint sibilant rale over the base of the 
right lung. She was largely bled from the arm, and put 
on nauseating doses of antimony. On the following 
morning, May 3, she had less headache; the sibilant rale 
at the base of the right lung was replaced by moist 
bubbles, and she raised during the act of coughing, 
which was now less constant and more paroxysmal, a 
quantity of highly aerated sputa, resembling the white 
of eggs when beaten into whips. The signs in other 
respects were unaltered. 

On the 4th, subcrepitant rale was still heard over 
the base of the right lung, but unaccompanied with dul- 
ness on percussion, tubal respiration, increased vocal 
resonance, or other signs of pneumonia. The general 
symptoms having undergone no abatement, she was 
again bled freely from the arm, and put on calomel, 
nitrate of potash, and ipecacuanha, in addition to the 
antimony, besides a Dover's powder at bedtime. 

This condition of things continued for eight days, at 
the end of which time, with a calmer respiration and 
diminished , cough, the frothy expectoration ceased, a 
little viscid sputa taking its place; the pulse became 
more tranquil, the moist sounds at the base of the right 
lung cleared up, and finally convalescence was perfectly 
established. 

About a week after this lady had left her sick-bed, 
when the cough had entirely disappeared for some days, 
and her general health seemed in a great degree restored, 
she took a sponge-bath, the air of the apartment being 
at the time rather cool. The result was a relapse, with 
a renewal of all the symptoms attending the first attack; 
the moist sounds returning and continuing at the base 



AXD RHEUMATIC PXEUMOXIA. 25 

of the right lung until the close of the seizure, which, 
in spite of the most active antiphlogistic means, termi- 
nated her life on the 29th of May. 

Believing that the fatal issue in this case could not 
result from a bronchitis so limited, and suspecting the 
existence of some latent pneumonia or other mischief 
not betrayed by the signs or symptoms, the following 
inquiry was instituted : — 

Examination, twenty-four hours after death. — Much ema- 
ciation ; unusual cadaverous rigidity of the joints, with 
firmness of the muscular structures. No adhesion of the 
capsule of either lung to the costal pleura. The outer sur- 
faces of both lungs present the usual appearance of health, 
except the lower lobe on the right side, which is of a 
pale red. This redness, exactly limited to the third or 
lower lobe, and commencing where the larger bronchus 
enters it, is nearly uniform, but of a deeper shade of 
color on the posterior face. The adjacent lower surface 
of the middle lobe presents to the eye the usual mottled 
pale gray appearance of healthy lung. Cells throughout 
filled with air, each part of every lobe crepitating on 
pressure; the lower lobe of the right lung being just as 
compressible and crackling as the others. Left lung — 
bronchia, when laid open, present nothing unusual ; 
parenchyma perfectly healthy, with the exception of two 
old cretaceous particles surrounded with slight melanotic 
deposit. Eight lung — larger bronchi filled with a frothy 
serum and some viscid mucus. The lesser tubes of the 
two upper lobes contain neither of these fluids. 

In the third, or lower lobe, the air-tubes, great and 
small, are filled with a highly aerated viscid secretion. 
From the cut surfaces of the parenchyma a bloody serum 
exudes, but there is nothing resembling even the first 
stage of pneumonia; the partial engorgement of the 
different lobules seeming to result from intense injection 



26 FIBROUS OR RHEUMATIC BRONCHITIS 

of the delicate nutritious bloodvessels supplying the 
terminal air-tubes, and not from congestion of the capil- 
laries, which, surrounding the air-cells, convey the blood 
from the pulmonary arteries to the corresponding pul- 
monary veins. The bronchi running into this lobe being 
laid open and washed, present but very faint traces of 
anything like inflammation. Their epithelial or mucous 
surfaces seem smooth and polished ; here and there a 
point of redness may be seen, and in one or two spots the 
white vessels seem to be injected with the coloring matter 
of blood. This membrane is neither thickened nor soft- 
ened, but at many places it appears to be elevated, as if 
by injection of, or transfusion from, the capillaries which 
lie underneath it. Sections of these tubes, when sepa- 
rated from the surrounding parenchyma and washed, 
exhibit, by transmitted light, irregular spots of a dusky 
or brownish hue, which serve in great measure to destroy 
the diaphanous character of the structure. Heart per- 
fectly healthy. The right auricle and ventricle contain 
much fibrin, ropes of which are also found in the adja- 
cent vessels. Stomach and intestines healthy. 

This post-mortem examination serves only to confirm 
the previous signs, but gives no additional information 
as to the cause of death ; on the contrary, it discovers 
lesions altogether so trivial that it would be unphilo- 
sophical to assign them as the causes which induced the 
fatal result. 

Here, then, is an important problem, the solution of 
which is of vast importance. How is it that one indi- 
vidual recovers without difficulty from a diffused catarrh 
in which all the bronchi of both lungs are involved, while 
another dies of a local bronchitis involving only the air- 
tubes of a single lobe? And why is it that one patient 
may die from two square inches of pneumonic engorge- 
ment, while another, treated in the same manner, re- 



AND RHEUMATIC PNEUMONIA. 27 

covers readily from a pneumonia involving one entire 
lung? 

When a man is treated for and dies of pneumonia, or 
any other affection, and an autopsy is made, the attending 
physician is satisfied, because his diagnosis is proved to 
be correct. And correct it doubtless might be, as far as 
his observation and the present state of medical know- 
ledge enabled him to go ; but did he diagnosticate the 
condition in which the patient died, and provide properly 
for the dangers which it involved? The question should 
always be asked, loliy did the individual die of pneumonia^ 
or of this or that disease, as the case may be ? Hundreds 
of patients have recovered from pneumonia involving 
twice as much of the pulmonary parenchyma as we 
find in the supposed case, and why, therefore, did this or 
that individual die of the particular lesion discovered? 
What were the antecedents, the supervening accident, or 
the associated circumstances, which induced the fatal re- 
sult? Of what morbid condition did the patient die? 
These are questions which may generally be answered 
at the bedside, but can seldom be solved in the dead- 
house. Where the alterations of the solids are insuffi- 
cient to account for death, may we not in many cases 
look to the condition of the fluids for the cause? 

Rheumatic pneumonia differs so widely in its history, 
mode of production, and general phenomena, from all 
other forms of pulmonary engorgement, that it would 
seem to deserve a separate consideration. The writers 
of the past century describe this disease, but with such 
bewildering indefiniteness, that it is quite impossible to 
form any conjecture as to their real meaning. 

Some authors of the present cycle assign metastasis of 
rheumatism to the lungs as one of the causes of pneu- 
monia; but they have not shown wherein this disease 
differs from other forms of pulmonary engorgement, nor 



28 FIBROUS OR RHEUMATIC BRONCHITIS, ETC. 

have they pointed out, or even hinted at, the relation 
which it bears to, and its necessary dependence on, pre- 
existing fibrous bronchitis. 

The writer looked with much interest to the recent 
comprehensive and admirably systematic work of Dr. J. 
A. SwettjOn diseases of the chest, and to the transatlantic 
labors of Dr. Walshe, in the same department, for some 
elucidation of these important topics; but both of these 
gentlemen, in considering bronchitis and pneumonia, have 
followed, with few variations, in the tracks of their pre- 
decessors. 

Dr. Walshe, in the last edition of his concise and much 
improved book on diseases of the lungs, at the head of 
his chapter on bronchitis, defines this disease as " inflam- 
mation of the mucous membrane of the bronchial tubes." 
He, and all the writers who preceded him, seem to have 
believed that the bronchial tubes proper possess a general 
immunity from disease, since they have failed to make 
them subjects of even passing pathological comment. In 
speaking of the efficacy of bleeding in acute bronchitis, 
Dr. Walshe says (p. 244), that '^rarely is repetition of 
general bloodletting called for by the violence of the 
disease; and while the abstraction of large quantities of 
blood, with a view of putting an immediate close to the 
disease, is perfectly chimerical, such sacrifice of blood is 
useless for an object assigned by some writers — thepre- 
?;en//o/i of pneumonia — seeing that, in the adult, idiopathic 
inflammation of the tubes does not pass on to the paren- 
chyma." It is true that, in the adult, mucous bronchitis 
does not run into pneumonia; but the cases presently to 
follow will show that, in fibrous inflammation of the 
bronchi, the reverse is the case, the parenchyma of the 
lung often becoming involved; so that Dr. Walshe and 
others are in error, not only as to their pathology, but 
also as to the therapeutic efficacy of the lancet. 



ON THE 



VASCULAR MECHANISM 



PULMONARY CIRCULATION 



Ix order to appreciate fully the various lesions of 
circulation that occur in acute diseases of the lungs, it 
is well to remember, at this time, some of the points 
connected with the vascular mechanism of these organs. 

All other structures of the body receive comparatively 
a small portion of the circulating current, either for their 
nutrition, or to furnish the materials for secretion ; the 
lungs, on the contrary, performing the great function of 
oxidation for the whole economy, have not only all the 
blood of the body passing through them at each round 
of the circulation, but, at the same time, are supplied by 
two bronchial or nutritious arteries, proportionate in size 
to the alimentary vessels of most other organs of like 
weight and bulk, by means of which the nutrition of the 
pulmonary parenchyma is carried on. And not only so, 
but the functions performed by these two pulmonary 
circulations are so nearly independent and distinct, that 
most of the return blood from the bronchial arteries is 
returned by two corresponding venous trunks, one of 
which enters into the vena azygos on the right side, and 
the other into an intercostal vein on the left ; and their 



30 ON THE VASCULAR MECHANISM 

currents, soon mingling with the torrent of the general 
circulation, pass directly back again to the lungs, to be 
deprived of carbon, in common with the accumulated 
volume of venous blood from the general economy. 

A small portion of blood from the bronchial arteries^ 
goes to nourish the walls of the air-cells, and, parting 
with its carbon the moment it receives it, returns directly 
through the pulmonary veins to the left side of the heart. 
It is in this respect alone that these two distinct circu- 
lations have either capillary connection with, or vascular 
dependence on, each other. With the exception, then, 
of this very slight connection, the lungs have two distinct 
and independent vascular arrangements, one of which is 
concerned in oxidation and general depuration, and the 
other solely in local nutrition and waste. Derangements 
in the physiological performance of these pulmonary cir- 
culations constitute the vascular lesions, which become 
of prime importance in the consideration of both pneu- 
monia and bronchitis. 

It may be remembered, also, in this connection, that 
the pulmonary arteries have not only the anatomical 
character, but also the functions of veins, to perform in 
(rUi-£-^ conveying -4he- blood, and that their walls are thinner, 
and do not possess the elasticity belonging to the arterial 
tunics. These vessels are,' therefore, more liable to be- 
• come receptacles for the gathering together and retention 
of abnormal quantities of venous blood, when, from 
states of chill, adynamia, pulmonary engorgements, or 
other causes, its passage through the lungs is retarded. 

In simple inflammatory engorgement of the lungs, the 
pulmonary vessels are the sources and seats of congestion, 
while the bronchial or nutritious arteries furnish the 

^ See a paper by Mr. Rainey, Medico-Ghirurgical Transactions, for 
1845, and Davies on Diseases of tlie Heart and Lungs, p. 17. 



OF THE PULMONARY CIRCULATION. 31 

materials for inflammation. Splenization of the lung 
furnishes an example of simple congestion in the capil- 
laries of the depurative circulation, and shows a condition 
in which the terminal pulmonary veins and arteries are 
alone implicated. On the other hand, congestion or in- 
flammation of the bronchial structures aflbrds an exam- 
ple in which the capillaries of the nutritious arteries 
and veins are alone involved. 

Let it be supposed that a fourth of the whole pulmo- 
nary parenchyma labors under pneumonia, then one- 
fourth of the channel by which the blood passes from the 
right to the left side of the circulation is seriously ob- 
structed, or entirely cut off, and increased action of the 
heart is required to force the blood through the diminished 
passage from the venous to the arterial side of the circu- 
lation. Under these circumstances, an individual whose 
pulse in health is eighty, must require, when laboring 
under the specified degree of pulmonary engorgement, 
to have his heart contract one-fourth oftener, or to beat 
one hundred times in the minute, in order that his circu- 
lation may still go on. That nature often obviates this 
necessity to a certain extent, by accommodating a por- 
tion of blood in the spleen, and in the large veins about 
the heart, lungs, and portal vessels, and thus withdrawing 
it from the moving current, is very true; and that art 
often accomplishes the same end, by abstracting blood 
from the circulation, is equally true; but, in spite of 
these conservative provisions, there will be more or less 
obstruction to the pulmonary circulation so long as the 
engorgement lasts. 

The same position is true with regard to the respira- 
tion, the ratio of its frequency bearing a very uniform 
proportion to the amount of respiratory surface cut ofi* 
from atmospheric contact. Thus, in lobular pneumonia, 
it is well known that, where other signs fail, the fre- 



dZ ON" THE VASCULAR MECHANISM 

quency of the respiration is a very fair index of the 
degree of engorgement. A child, whose respiration in 
health is twenty, will very surely have its frequency 
augmented to forty or sixty, where the functions of one- 
half of the pulmonary air-cells are disabled by pneu- 
monia or its consequences. The great value of this 
reasoning is, that it goes to prove the leading importance 
of free bleeding in pneumonia. 

Ordinary pneumonia commences with congestion in 
the capillary vessels of the depurative circulation, and 
it is only when these passively dilated tubes come to be 
irritated by the retained globules, or by the presence of 
some salt which renders the retained fluid exciting to 
the nervous organization of these delicate vascular walls, 
that a morbid afflux of blood takes place through the 
nutritious artery to the point of congestion, bearing with 
it the materials for inflammation, and causing the termi- 
nal extremities of that vessel to pour out its plastic 
lymph. 

This congestion, by packing to repletion the depura- 
tive capillaries, causes the serum of the retarded blood, 
by a process of mechanical transudation, to soak through 
their walls into the interstitial cellular tissue, whereby 
another source of obstruction to the pulmonary circulation 
is established. And thus passive congestion, mechanical 
transudation, and the more active work performed by 
the nutritious arteries, in pouring out plastic lymph, are 
the phenomena which, together, constitute inflammatory 
engorgement of the pulmonary parenchyma. 

In anemic and hydremic subjects,^ congestion of the 
lungs resulting in pneumonia often arises from asthenic 
states of the nervous system. Under these circumstances, 
tonics and stimulants often accomplish the same bene- 



1 a Q, 



aiifiuis moderator nervorum." 



OF THE PULMONARY CIRCULATION. 33 

ficial ends as are seen to occur under an opposite state 
of things, or in plethoric subjects, from bleeding and 
antimon}^ And, in innumerable instances, it is neces- 
sary to stimulate and bleed at the same time, in order 
to bring about successful results; for, without the adop- 
tion of both plans, the institution of either singly is 
attended with danger to the patient. Suppose a healthy 
individual, struck down by a pneumonia, is found, on 
the second day of the disease, with more or less engorge- 
ment, and that his condition is marked by a cold surface, 
hippocratic face, and a lethargic state of the nervous sys- 
tem. Put him in a dry room, heated to 70° or 75° Fahr. ; 
give him brandy, and bleed him largely ; and, with proper 
subsequent treatment, he will very surely recover; fail 
to do any one of these things, and he will just as surely 
die. No dogmas have impeded so much the, successful 
advance of practical medicine, as the stimulant and 
contra-stimulant doctrines; for, although theoretically 
these principles are made to appear contradictory and 
opposed to each other, yet experience has proved that 
the contemporaneous use of both plans will often effect 
cures which the adoption of either, singly, would fail to 
accomplish. 

Having explained the mode in which the vascular 
lesions take place, and the order of their occurrence in 
ordinary pneumonia, it is well to remember that the 
fibrous tissue of the bronchi is traversed solely by the 
minute branches of the nutritious arteries, and that, 
where symptomatic pneumonia happens as a conse- 
quence of fibrous bronchitis, the order in which the 
vascular lesions take place is precisely the reverse of 
their occurrence, as already pointed out, in simple un- 
complicated pneumonia. Insoluble uric acid, or its 
compounds, phosphates, or the extractive matters found 
in the urine, not being eliminated from the blood, are 
3 



34 ON THE VASCULAR MECHANISM 

deposited in the meshes of the fibrous tissue, exciting 
nervous irritation, followed by vascular lesions, exuda- 
tions, transfusions, and all the general phenomena inci- 
dent to rheumatic inflammation. This process having 
set in, a symptomatic remora of blood takes place in 
the depuratory capillaries belonging to the inflamed 
bronchi, and a congestion, leading to engorgement, reach- 
ing the first or second stage of pneumonia, and rarely 
going beyond it, often takes place. This form of inflam- 
mation is propagated from the fibrous tissue of the 
bronchi, both by contiguous and continuous sympathy. 
Where the rheumatic inflammation is propagated to 
the pulmonary parenchyma by contiguous sympathy, 
the pneumonia is apt to be limited, and the engorgement 
is found wrapping, to a greater or less extent, one or 
more of the larger bronchi, constituting what is under- 
stood by central pneumoiiia, a comparatively rare variety 
of this disease. But when the inflammation extends by 
continuity, along the fibrous tissue of the bronchi, to the 
air-cells, the pneumonic engorgement found on the peri- 
phery of the lung is generally limited, but often diff'used, 
involving more or less of one or both lungs; and, in 
rare instances, sudden death occurs from an active hy- 
persemia taking place throughout the whole pulmonary 
parenchyma, constituting what Laennec has well de- 
scribed as suffocative catarrh associated with pneumonia 
(Herbert's edition of Laennec, pp. 207 and 93). Again: 
the rheumatic element is also transferred from one lobe 
of a lung to another, by the same law of metastasis which 
is observed in the rheumatisms of the white and fibrous 
tissues of the body generally. But this vascular sym- 
pathy of contiguity or continuity becomes still more 
important where idiopathic pneumonia and fibrous bron- 
chitis occur contemporaneously, but as separate and 
distinct affections, in the same lung; for, under these 



OF THE PULMONARY CIRCULATION. 35 

circumstances, when the ah^eady existmg engorgement 
of the pulmonary parenchyma comes to be intensified 
by the rheumatic element, the congestion surrounding 
the diflerent pulmonary structures is so absolute, and 
the pressure on the surrounding vessels so great, that 
the circulation in the delicate and tortuous branches of 
the nutritious arteries is in many places as effectually 
cut off as though a ligature were tied about them, and 
death of the lobules, thus deprived of nutrition, or gan- 
grenous eschars, are the necessary results. Could this 
accident ever result from simple uncomplicated inflam- 
matory engorgement, its frequency would, of course^ be 
much greater than it has been ascertained to be. 

These considerations go to show how fatal plethoric 
states of the circulation must often prove to individuals 
laboring under pneumonia, and to prove the great value 
and importance of depletion for the relief of ordinary 
inflammatory engorgement of the pulmonary paren- 
chyma, compared with the advantage to be derived from 
diminishing plethora in almost any other acute affection. 
And as bleeding is known to be of such signal advantage 
in simple pneumonia, how much more important it must 
be to relieve plethora, where this disease happens to be 
concurrent with, or symptomatic of, rheumatic bronchitis, 
which last affection exerts so great a control over the 
oriorin,- intensitv, and duration of the other. 

Loss of blood in pneumonia removes congestions, 
lessens the action of the nutritious arteries, and renders 
the circulation thirsty, if it may be thus expressed, so 
that the fluids forming the congestion are taken up, and 
removed by siphonic acts of the surrounding vessels. 
There are two modes by which pneumonia recovers, one 
by secretion or exudation, and the other by absorption. 
Every one must have noticed that where large depletion 
has been practised, the lung returns to its healthy con- 



36 MECHANISM OF PULMONARY CIRCULATION. 

dition by absorption, and without much exudation of 
fluids into the bronchial tubes ; but that where the dis- 
ease has undergone resolution spontaneously, the ple- 
thoric state of the circulation not having been removed, 
the engorgement recovers by a process of melting down, 
or by transudation and excretion from the cell and 
terminal bronchial surfaces. 



RHEUMATISM 



RHEUMATIC ELEMENT. 



No one who reviews the medical literature of present 
and past times, can help wondering at the' vast space 
occupied by the consideration of this important affection; 
nor can he fail, at the same time, to admire the zeal, 
industry, and patience, which led the older writers, espe- 
cially, to bestow on it so large a share of their time, labor, 
and reflection.^ 

We are told that the first writer to use the term 
" Rheumatism" was Themison, who practised medicine 
at Rome during the reign of Augustus.^ '' Le rhuma- 
tisme connu, auparavant sous le nom de goutte aigue ou 
epidemique, lui est redevable de la place qu'il occupe 
dans la nosologie." 

In the Compend. de Med. Pratique, art. " Rhuma- 
tisme," and in Van Swie ten's Commentaries (xviii. 2), is 
the following, from Coelius Aurelianus : " Est autem passio 
generaliter acuta, atque strictura suflfecta, adjtmcto levi 
humor is jiuore, quem rheumatismum vocant." 

^ I have here to express my indebtedness to Dr. A. Stille, who kindly 
furnished me with several authorities relating to some points connected 
with the subjects under consideration. 

2 Sprengel, Hist, de la Med. ii. 22. 



38 RHEUMATISM 

From the remote period at which these writers hved 
till now, innumerable authors have treated of this affec- 
tion under the heads of rheumatismus, arthrodynia, 
dolores rheumatici, myositis, myitis, cauma rheuma- 
tismus, arthrosia acuta et chronica, arthritis rheum atica, 
febris rheumatica, &c. &c. 

It is here intended not to make a long voyage in 
search of truth on the oceans of doubt and confusion 
presented by the numberless authorities on rheumatism, 
but simply to refer to those who have in anywise 
alluded to its connection with acute inflammatory affec- 
tions of the chest. 

A number of medical writers, particularly the humoral 
pathologist^, long ago noticed a relation between rheu- 
matism and acute diseases of the lungs; but they refer- 
red to this connection so vaguely and indefinitely, that 
subsequent authors, unable to glean from them any 
available principles or established facts, have unwisely, 
it is thought, neglected the whole subject. 

Writing on rheumatism, Tissot says -} " II n'y a point 
de partie que cette douleur n'attaque . . . elle se jette 
aussi sur les parties interieures. Sur le poumon elle 
occasionne des toux tres opiniatres, qui enfin degenerent 
en maux de poitrine tres graves." 

"• Lorsque le rhumatisme se porte sur les hronclies^ 
dit Rodamel en traitant du rhumatisme chronique, il 
existe une toux avec gene plus ou moins grande dans la 
respiration, qui semble ne point differer de la toux ca- 
tarrhal connue sous le nom de rhume;" . . . '^D'apres 
le caractere de la matiere expectoree dans le cas de' rhu- 
matisme sur les bronches, c'est sans doute a cette espece 
d'affection que doit se rapporter la maladie de poitrine 

* (Euvres, i. 241. 

^ Diet, des Scien. Med. xlviii. 548, art. Rhumatisme. 



AND THE RHEUMATIC ELEMENT. 39 

eprouvee par d'Yvoiry, medecin de Lyon, et dont il 
donne la relation sous le titre de Metastase rhumatis- 
male sar la poitrine, avec menace de plithisie, dans un 
Essai de Medecine publie conjointement avec ses con- 
freres Morizot et Brion." . . . Again (p. 549): "Le 
farencliijme des poumons est beaucoup plus rarement 
affecte par la metastase rhumatismale que les membranes 
qui y adherent. Aussi, a peine trouve-t-on dans les 
auteurs quelques traces d'observations de peripneumonie 
de ce genre. Quant a la pleuro-peripnettmonie, elle est un 
pen moins rare, et Rodamel en rapporte un exemple fort 
remarqaable. Selon cet auteur, la peripneumonie rhu- 
matique est toujours precedee de douleurs rhumatismales 
dans les extremites." Then as^ain:^ "La metastase rliu- 
matismale sur la poitrine peut ne determiner que les 
affections convulsives connues sous les noms d'asthme et 
d'angine de poitrine. Rodamel a vu la premiere de ces 
maladies survenir apres la disparition d'un rhumatisme 
cbronique qui avait son siege a la cuisse et a la jambe." 
And again :^ "Rien de plus ordinaire que la complication 
du rhumatisme et du catarrlie pulmonaire ; maladies qui 
surviennent en quelque sorte indifferement sous I'influ- 
ence des memes causes. . . . Dans I'epidemie catarrbale 
de 1574 decrite par Baillou, les malades eprouvaient 
dans les omoplates et dans la poitrine, des douleurs 
vagues semblables a celles de la pleuresie." 

Sydenham and Etmtiller noticed that muscular rheu- 
matism was a very constant accompaniment of the influ- 
enza, which prevailed under their observation in the year 
1676. Huxham remarked the same thing during the 
epidemic catarrhs of 1737 and 1743, and says that most 
of his patients suffered with distressing pains in the 

* Diet, des Scien. Med. xlviii. 551. 
2 Ibid. p. 570. 



40 RHEUMATISM 

head, back, and limbs. And Storck makes mention of 
a grave form of catarrhal fever complicated with acute 
rheumatism. 

In describing " le catarrhe goutteux du poumon," Bar- 
thez says •} " Entre toutes les inflammations rhumatis- 
males des visceres il n'en est point d'aussi commune que 
la pleuropneumonie rhumatismale." 

StolP says : " La meme humeur rhumatisante, quand 
elle se jetoit, &c. . . . Les coryza, les migraines rliuma- 
iismales, les douleurs de dents^ d'oreilles^ les fluxions sur les 
Jones, les eyirouemens, et les catarrhes de j^oitrine propre- 
ment dits, n'avoient pas une autre originer And again -? 
" L'humeur rhumatisante abandonnoit les membres su- 
bitement, et au moment ou on s'y attendoit le moins; et 
elle se portoit sur la portrine, on elle occasionnoit la 
dyspnee et I'orthropnee, avec une toux tres violente, de 
I'oppression, et des crachats quelquefois sanguinolens." 

The relation between rheumatism and diseases of the 
heart appears to have been understood by Pinel, and by 
Meckel, of Berlin, and was very distinctly pointed out 
by Mathey and Odier, about the beginning of the present 
century. "L'afFection rhumatismale du coeur, dit Odier, 
se reconnait par les palpitations, les angoisses, les syn- 
copes ; symptomes que sont quelquefois mortels ; quelque- 
fois aussi ils subsistent apres le rhumatisme, et degenerent 
en maladies chroniques." 

It is owing, most probably, to the clearness and dis- 
tinctness of the above statement, that" the connection 
between rheumatism and heart disease is so well under- 
stood at the present day; and, on the other hand, it can 
only be ascribed to confusion and vagueness of description, 
that the still more important relation of rheumatism with 

^ Diet, des Seien. Med. ii. 128. ^ (Euvres, i. 57. 

^ Ibid. iii. 71. 



AND THE RHEUMATIC ELEMENT. 41 

acute affections of the lungs has been so completely over- 
looked by recent observers. 

Bouillaud and Chomel adopted the ideas of their 
predecessors as to the common origin of heart disease; 
but they deserve on that account no less credit for 
having confirmed and established, beyond the power of 
contradiction, the truth of the doctrine. 

The great Boerhaave. who caused the University of 
Leyden to flourish so rapidly, and whose genius exerted 
such entire sway over the medical mind for more than 
a century, says, in the very last of his practical aphor- 
isms : '' There is a disease allied to the gout and scurvy, 
which is very common in England, and. is called a rheu- 
matism, which is preceded by a sanguine constitution 
infected with some sharp defect, manly age, plentiful 
living, a sudden cooling of a heated body, spring and 
fall, transpiration interrupted, an inflammatory dispo- 
sition, but showing itself slower than in pleurisy. It 
begins with. a continual fever, creates a most terrible, 
tearing pain, increasing cruelly upon the least motion, 
long continued and fixed in one place, -atec^fSSJH^ the ffl^t^i/i^ 
joints of any limbs, but most particularly troublesome 
to the knees, loins, and rump-bone, excruciating, and 
invading sometimes the brain, lungs, and bowels, Avith a 
tumor and redness of the place, and going ofi* and 
returning again by fits." And again : " Its proximate 
cause seems to be an inflammation of the lymphatic 
arteries of the membranes w^hich are about the liga- 
ments of the joints, but not fierce enough to change it 
into an imposthumation." . . . " Hence appears why 
this disease is so frequent, and is seen in so many shapes, 
and is very dangerous if it invades the brain or lungs ; 
and why it is difficult, then, to find out the same." 

The translator and publisher of these aphorisms adds, 
in a note : "Our author had forgot to treat of this disease 



42 RHEUMATISM 

in his former editions, and, truly, I never heard him 
make any mention of it in his lectures during two years 
I constantly attended him," &c. 

Yan Swieten says^ that Boerhaave suffered under a 
mild form of rheumatism in 1721, and that in the sum- 
mer of 1722 he had a very severe seizure, lasting many 
months, and adds: ''Perhaps, as he had suffered this 
pain the former year, though in a less degree, and less 
stubborn, it incited him to treat of this affection. This 
was before he was attacked with that violent fit. These 
things, when considered, may not seem absurd. But all 
that he writ concerning the rheumatism does not fill 
two short pages, and concludes the aphorisms. Besides, 
such was the firmness of mind in this excellent man, 
that, I doubt not, he writ them during that terrible 
disorder." 

Now, in order to appreciate correctly the value of the 
suggestions contained in the foregoing quotations, it is 
well to remember, at this time, the etymology of the 
word rheumatism, so that the full meaning of the various 
authors who refer to this disease, or to a rheumatic ele- 
ment, as the producing cause of acute chest affections, 
may be the better understood. Rheumatism is a modern 
form of the word rheumatismus, or pev^ana^og, from 
psv[iarL^cd, to be afflicted with defluxions. Now, by a 
defluxion was understood a coryza, catarrh, a descent of 
humors from a superior to an inferior part, or the collec- 
tion of them on some point or organ. The word humor 
was applied to any fluid of the body. Peccant humors 
signified fluids or secretions in a state of disease. 

A defluxion or discharge of rheum from the nose or 
bronchial tubes signified precisely what we understand 
by catarrh, as the etymology of the words will farther 



* Commentaries, xviii. 4. 



AND THE RHEUMATIC ELEMENT. 43 

show. Now, it would appear that rheum, when dis- 
charged externally, as in bronchitis, was not regarded by 
the humor alists as the product of a mucous membrane 
secreted by mucous follicles, but as a fluid, owing its 
origin and continuance to the accumulation, from within, 
of the morbid humor on the lungs. 

The older writers differed, not only as to the character 
of rheumatic inflammations, but also as to the nature of 
the element or humor which produced them; some 
regarding the disease as a simple phlegmasia; while 
others, and especially the humoral pathologists, looked 
upon it as a special inflammation. Many of the latter 
use the term rheumatism in a general sense, having 
reference to a variety of diseases in various organs; 
while others restrict its signification to inflammations 
affecting synovial capsules, or fibrous and sero-fibrous 
tissues. And as to the producing element or peccant 
matter giving origin to the inflammation, some appear 
to have thought that it depended upon a number of 
morbid humors or deflaxions, differing under various 
circumstances. Many more, 'entertaining an opposite 
opinion, believed the phlegmasia to be induced in all 
cases, wherever seated, and without regard to the ana- 
tomical composition of the structure, whether paren- 
chyma, mucous membrane, or fibrous tissue, by a peculiar 
arthritic acrimony or rheumatic essence. 

Stoll, for example, speaks of rheumatism in both a 
general and special sense. In his great work, Medecine 
Pratique, where diseases are arranged according to the 
seasons of the year in which they were observed, rheu- 
matism is constantly spoken of, and "I'humeur rhu- 
matisante" is made the grand producing cause of a 
variety of diseases, widely different in character, and 
affecting very dissimilar structures. On the contrary, 
in his ApJiorisms, where he refers to these same affec- 



44 RHEUMATISM 

tions, the term rhumatisme is rarely used ; but we find, 
on page 46, the words " une acrimonie arthritique," which 
convey a meaning definite, concise, and restricted, but 
just as unintelligible as ^'I'humeur rhumatisante." 

And having spoken of the difference between true 
inflammation and rheumatic inflammation, he writes a 
chapter {Med, Pratique, i. 273) on a "Fievre rhumatis- 
male cVorigine hilieuseJ' He then speaks of rheumatism 
as a cause of enteritis, and in another place endeavors 
to establish a relation similar to that already noticed in 
regard to catarrh, between dysentery and rheumatism. 
This last opinion of Stoll has, however, been successfully 
controverted by M. Bouillaud. 

^gineta says-^ that " any humor which is not natural, 
or a weakness of the particles, may bring on a disease 
of the joints." And of the morbid element in question, 
Bonetus says : " Morbus a serosi, salsi, fervidissimi, ac 
tenuissimi humoris, jecoris vel lienis vitio in vasis cumu- 
lati decubitu exortus." So Ballonius, too, describes 
rheumatism as " conferta humoris serosi diluvies." 

The great Boerhaave, who speaks in his lectures of at 
least a dozen different humors, was reflecting and writing 
on defluxions, their causes and effects, all his life, and 
yet he appears not to have had the faintest idea of true 
rheumatism until he suffered from a severe attack of this 
disease in his own person. In the whole six volumes of 
his works he never mentions rheumatism, and yet, 
according to the etymology of the word, he had been 
writing on it, and little else ; and when the labor of his 
life was over, and the first edition of his books published, 
he seems suddenly to have discovered, from his own per- 
sonal experience as an invalid, that he had been narrating 
medical dreams all his life, and that he had at last to 

* Van Swieten, xviii. art. Rheumatism. 



AND THE RHEUMATIC ELEMENT. 45 

describe a painful reality. He must have resolved, at 
the very outset of his career as a lecturer and writer, 
never to use the word rheumatism, however much he 
might think and write about it, seeing how much, and 
to what little purpose, his remote and immediate prede- 
cessors, especially Sydenham and Musgrave, had already 
spoken and written on the subject. 

Finally, it would appear from all that we have gathered, 
that the older writers had no uniform or established opi- 
nions common amongst themselves, either as to the com- 
position of these humors, their modes of conveyance to 
the seat of the affection, or the number and character of 
the diseases which they were supposed to produce. 

At the present day, we find the medical mind still 
divided as to the essential or non-essential characters of 
rheumatism. Chomel, at the head of one sect, believes 
it to be a disease sui generis; he says: "Le rhumatisme 
a une nature propre et specifique." Bouillaud, at the 
head of an opposite class, regards rheumatism as a true 
inflammation, modified only by the character of the 
structures involved. They both agree as to its seat, and 
confine its signification to inflammations of the synovial, 
fibrous, and sero-fibrous tissues. But, as to the rheu- 
matic element, Chomel is no less obscure than the other 
writers. He informs us that the inflammation is peculiar 
and essential, but he is not clear as to the first ingredient 
or principle which confers on it, in addition to the ordi- 
nary phenomena of inflammation, " une nature propre 
et specifique." 

Graves^ describes a case of arthritis, " combined with 
inflammation of the bronchial mucous membrane." 
The subject of this attack — Loghlan — had suflered, he 
says, on previous occasions, from repeated attacks of 

^ Clinical Lectures, p. 346. 



46 RHEUMATISM 

articular rheumatism. Dr. Graves, falling into the error 
of all other writers, does not refer the pulmonary mis- 
chief to its true seat — the fibrous and cartilaginous 
tissues of the bronchi — but describes graphically the 
characteristic cough which attends these cases, where 
the articular inflammation and the fibro-bronchitis hap- 
pen contemporaneously. He says: "Every time the 
patient coughs, he feels like one stretched upon the rack; 
at every convulsive motion of the chest a severe pang is 
felt in every joint, and the ordinary rate of suffering is 
increased to positive agony." 

The only modern writer who has alluded, with any 
degree of distinctness, to the connection between rheu- 
matism and acute diseases of the lungs, is Latham, in 
his lectures on rheumatism. He speaks of it only as a 
symptomatic affection, and has noticed that the lungs 
were more or less implicated in every 5 J cases. He 
says, farther: "In the four examples of bronchitis 
occurring out of 136 cases of acute rheumatism, the 
affection was nowhere mere catarrh, but an inflammation 
largely diffused through both lungs, producing deep 
oppression and dyspnoea." 

It was very explicitly stated, at the outset, that the 
disease under consideration in this essay is seated in the 
fibrous and cartilaginous tissues of the bronchial tubes. 
And with regard to the rheumatic element, it is now pro- 
posed to define, as concisely and clearly as possible, what 
the author believes to be the ingredients directly con- 
cerned in the production of fibrous bronchitis, and of 
rheumatic inflammation generally, in whatever portion 
of the synovial, fibrous, or white tissues it may occur. 

First. It is believed that the most common producing 
cause of rheumatism is the presence in the blood of 
insoluble litJiic acid and lithate of soda, which salts being 
arrested in the terminal bloodvessels supplying the 



AND THE RHEUMATIC ELEMENT. 47 

\Yhite tissues, act as irritants, and thus become the pri- 
mary link in the chain of morbid phenomena consti- 
tuting, so far as this cause is concerned, one form of 
rheumatic inflammation. For this diathesis, nitrate of 
potash, phosphate of soda, and the alkaline carbonates, 
are all excellent remedies, but phosphate of ammonia is 
incomparably the best solvent both of uric acid and of its 
compounds, this opinion is confirmed by the testimony 
of Dr. Bird. 

The salts of lithia, one of the alkaline bases, espe- 
cially the phosphate, succinate, and benzoate, would 
most probably prove valuable solvents of uric acid ; but 
the rarity and costliness of lithium, obtained from the 
minerals petolite, spodumine, and lepidolite, must ever 
prevent their being brought into general use. 

Secondly. It is believed that rheumatic inflammations 
of another class depend upon the retention in the blood 
of large quantities of nitrogenized matter, which is elimi- 
nated, during a healthy performance of the various 
functions, almost exclusively through the excretory ex- 
halants of the skin. 

A number of carefully conducted experiments, by 
Seguin and Anselmino, have proved that the average 
quantity of saline and organic matters exhaled from the 
whole cutaneous surface nearly equals that which is 
voided by the kidneys. That the skin is abundantly 
provided with emunctories for the performance of this 
important function, has been demonstrated by the labors 
of Mr. Erasmus Wilson, who counted on the hand 3,528 
perspiratory pores in a single square inch; and estimating 
the number of square inches on a man of ordinary 
height and bulk at 2,500, he deduced that there is an 
average of 700,000 pores through which the cutaneous 
drainage takes place. A healthy individual is constantly 
eliminating nitrogenized matter both by the f^kin and 



48 RHEUMATISM 

kidneys. In the fluids exhaled from the cutaneous sur- 
face, Faraday has detected ammonia, Berzelius has found 
osmazome, and a body resembling, if not identical with 
urea, has been recognized by both Golding Bird and 
Landerer. These, together with other nitrogenized in- 
gredients, the exact character of which is not understood, 
constitute about 707 grains of organic matter voided 
from the skin of a healthy individual in twenty-four 
hours. The reciprocal powers of compensation, which 
render the skin and kidneys so vicariously and inti- 
mately connected, are too well understood to require 
comment. It may, however, be stated, in general terms, 
that it is owing to disturbances in the balance of these 
two very similar functions that the erythematous erup- 
tions of the skin and nephralgic attacks happen so very 
much more frequently in the spring and autumn, and 
during variable weather, than at seasons when the tem- 
perature is equable. 

Transient exposure of the surface to cold, over-indulg- 
ence in meat diet, a fever of simple excitement occa- 
sioning a temporary waste of the tissues, and other 
trivial causes, give to the blood an excess of nitrogenized 
elements, which are soon voided by the kidneys in the 
form of urate of soda, lime, and ammonia. But such 
causes, producing an excess of these salts, are soon 
removed; if the individual exposed to cold gets into 
a warmer air, the action of his skin is resumed, the 
simple fever subsides, or, if an excess of nitrogenized 
matter exists in the blood, less meat is almost sure to be 
taken at the next meal, and thus instincts, growing out 
of the particular wants of the system, often regulate the 
supply. So true is this, that if a man feasts for several 
days together on canvasback ducks, venison, or any 
other highly nitrogenized food, he will be sure at last to 
loathe the particular articles which have already satu- 



AND THE RHEUMATIC ELEMENT. 49 

rated his 11 aids with azotized matters, and these must be 
gotten rid of through the skin and kidneys before his 
appetite for the food m question will again return. In 
thex same way, relish or distaste for salt food is regulated 
by the excess or deficiency of muriate of soda in the 
blood. And thus a dog that has eaten largely of animal 
food becomes, for a short time afterwards, an herbivorous 
animal. 

The simple and transient excess of the urates in the 
renal circulation furnishes, therefore, no indication" for 
treatment ; on the contrary, these salts are so extremely 
soluble that the kidneys have the power to secrete them 
in large quantities. But when, from long-continued 
exposure to cold, the existence of some forms of cuta- 
neous diseases, chronic gastro-enteritis, or other causes, 
the functions of the skin become seriously impaired ; the 
kidneys, having a double duty to perform, are often 
overtasked, and the result is that large quantities of 
nitrogenized elements are retained in the system, giving 
rise sometimes to distressing neuralgia, but oftener to a 
subacute form of rheumatism. 

Certain diseases of the skin have long been noticed 
amongst the predisposing, and w^ere believed to be in 
many instances the direct causes of rheumatism. The 
Dictionnaire des Sciences Medicales has the following in 
that portion of the article relating to the causes which 
give origin to, and predispose to this disease : " M. Gi- 
raudy, dans son edition de I'ouvrage de Raymond, sur 
les maladies qu'il est dangereux de guerir, rapporte avoir 
vu un rhumatisme cause par la repercussion d'une dartre 
farineuse." . . . "La repercussion (p. 448), la metastase 
d'un erysipele ou d'une eruption cutanee aigue quel- 
conque est souvent aussi la cause de la maladie dont 
nous traitons. On la voit surtout survenir a la suite de 
la rougeole et de la scarlatine." ..." Cyrilius, dans sa 
4 



50 RHEUMATISM 

vingt unieme consultation, troisieme centurie, parle aussi 
d'un rhumatisme cause par une rentree," &c. 

Some writers, looking upon these cutaneous eruptions 
as the effects rather than the causes of the inflammation in 
question, regarded their appearance as both critical and 
salutary. In the same dictionary, in sixty volumes, where 
the critical eruptions are spoken of, page 537, is the fol- 
lowing : " Aussi nous bornerons nous a dire igi en resume, 
qu'apres une duree indeterminee du rhumatisme, surtout 
de celui qui est aigu, on a vu survenir, en difle rentes 
parties du corps, tantot sur celles qui etoient souffrantes, 
tantot indistinctement, en quantite fort variable, et 
durer plus ou moins de temps, des eruptions qui ont regu 
le nom de gale, de dartre, de pourjpre, de vesicule,'' &c. 
" Tissot a vu la crise secondaire etre caracterisee par 
une eruption de vesicules, suivies d' ulcerations." And 
again : " Baillou pense que le principe qui produit ces 
differentes eruptions cutanees est le meme qui, etant sur 
les muscles ou les articulations, occasionne le rhumatisme." 

Baillou seems nearer the truth than those who regard 
the eruptions in question as amongst either the causes 
or effects of arthritic inflammation ; for why may not 
the functions of the skin be disabled, and eruptions 
result as a consequence of the drainage through its per- 
spiratory pores of fluids highly saturated with saline 
ingredients, just as nephralgia and, with a continuance 
of the cause, vascular lesions and inflammations of the 
kidneys are produced by the passage through their deli- 
cate vessels of irritating salts? 

In the examples quoted, it is hardly possible that the 
metastasis or retrocession of the eruptions had any share 
in the production of rheumatism, but far more likely 
that the existence of the cutaneous affections had dis- 
abled the functions of the skin, and consequently that 
the retained nitrogenized elements were the true cause 



AND THE RHEUMATIC ELEMENT. 51 

of the inflammation in question. Be this as it may; 
one thing is most certain, that where, from any cause, 
the perspiratory functions of the cutaneous pores are 
seriously impaired, the azotized materials thrown back 
upon the circulation are in part gotten rid of by the 
■vicarious acts of the kidneys, while the rest are retained, 
giving rise often to neuralgia, but still more frequently 
to subacute rheumatism. This condition of things is 
most generally brought on by constant exposure to a low 
temperature during sedentary occupations, and more 
particularly where these are carried on in apartments on 
the ground floor, or in cellars not duly ventilated and 
warmed. 

In this form of the disease, great palliative relief is 
often obtained from the exhibition of the hi tartrate and 
acetate of potassa, and also from the bicarbonates of soda 
and potassa; but the happiest effects result from the use 
of diaphoretics, hot baths, and all other agents calculated 
to restore the functions of the skin. 

When, from a sudden check of perspiration, an indi- 
vidual experiences a sense of aching in all his limbs — 
"courbature' — a hot-bath, a stimulating diaphoretic, or 
a pint of warm wine whey, with a Dover's powder at 
bedtime, generally affords prompt relief by restoring the 
function of the perspiratory pores. But when, from 
greater or longer continued disability in the functions of 
the skin, a fixed rheumatism exists, resort must be had 
to cimicifuga, eupatorium, or some other class of dia- 
phoretic agents, such as sulphuret of antimony, guaiacum, 
&c. If dyspepsia exists as a concomitant trouble, it is 
often requisite, at the same time, to direct special treat- 
ment to the peculiar condition on which it may depend. 
It is in the relief of excessively chronic cases of dys- 
pepsia, and more particularly that form of the disease 
depending on the foUicuIar gastritis of Andral, and asso- 



52 RHEUMATISM 

ciated with neuralgia and chronic rheumatism, that the 
Thomsonians and h^^dropathists, and advocates of the 
Russian bath system, claim their chief triumphs. In 
long-continued functional disorders of the skin and mu- 
cous membranes, either one of these classes of hardy 
empiricisms will, provided it do not kill, often effect a 
cure. 

Tliirclhj. There is a form of rheumatism dejoending 
on the abnormal presence of earthy phosphates in the 
blood; and, under these circumstances, an excess of the 
triple phosphates of lime, soda, and magnesia, will often 
be found in the urine, but not uniformly; the solvency 
of these salts, and consequent capacity of the kidneys 
to eliminate them, depending, in great measure, on the 
proportion of phosphoric acid united with the earthy 
bases. As superphosphates they are readily secreted, 
and generally render the urine only slightly turbid, but 
occasionally as white as milk; and, still more rarely, 
being precipitated to the has fond of the bladder, they 
come away in considerable quantities, and in form and 
consistence resembling soft mortar. 

When the supply of phosphoric or some other acid is 
insufficient to render these earthy bases soluble, they 
are retained in the blood, giving rise to dejDressions of 
the nervous system, pain in the back (particularly over 
the lumbar region), nerve ache, rheumatism, and some- 
times, on the point of being secreted, obstruct the tubuli 
uriniferi, giving rise to nephralgia, which may lead to 
congestion and inflammation of the kidneys. 

It is particularly this form of rheumatism which 
occiirs in the crowded wards of hospitals, where the 
nervous system of the inmates is depressed by previous 
diseases, and where they are constantly breathing an 
atmosphere charged with ammonia and carbon. It was 
probably this form of the disease which Sydenham 



AND THE RHEUMATIC ELEMENT. 53 

referred to when he spoke of scorbutic rheumatism. 
Saucers filled with muriatic acid, or some other suitable 
agent, ought to be constantly exposed in the wards of 
every hospital, in order to get rid of the ammonia, which 
not onlj^ acts as the vehicle for the spread of specific 
contagions, but serves, at the same time, together with 
other nitrogenized compounds and carbon, to depress the 
vitality of all who breathe it. 

It is in this form of rheumatism, depending on triple 
phosphates, that citric acid is found to act so happily. 
Good cider-vinegar (acetic acid), or an infusion of tama- 
rinds, will be found to act as well as lemonade. The 
lime, soda, and magnesia, which are here the immediate 
cause of diseased action, unite with citric, and still more 
readily with acetic acid, forming extremely soluble salts, 
which are easily eliminated by the skin and kidneys. 

Three varieties of rheumatism have thus far been 
spoken of, two of which, depending on the presence of 
certain salts existing in the blood, can be gotten rid of 
by the use of appropriate solvents, while the other form 
of the disease can generally be managed by restoring the 
functions of the skin. 

There is still a fourth variety of rheumatism, depend- 
ing, it would seem, upon the presence in the blood of 
those compounds which are found in the urine, and 
called extractive matters, the ^chemical composition of 
which is not yet ascertained. Cases resulting from this 
cause frequently run on for months or years, uninflu- 
enced by any known remedies, and, in spite of all experi- 
mental efforts to arrest their progress, result finally in 
permanent distortion of the joints, chronic bronchitis, 
with structural alterations of the heart, and, sooner or 
later, in death. 

These extractive matters are produced by some fault, 
either in the primary or secondary assimilation; and 



54 RHEUMATISM 

while there is no solvent alterative by which they can 
be gotten rid of, still, in some cases, their formation may 
be controlled, and in others prevented, by remedies 
addressed to the stomach, or by building up the general 
health and strength. 

Where the error consists in derangements of primary 
digestion and assimilation, much advantage is often 
derived from regulating the diet, giving bitter tonics, 
and such other agents as are likely, by improving the 
digestive process, to prevent the faulty elaboration on 
which the formation of the extractive matters in ques- 
tion depends. 

Where the stomach is healthy, and the fault is rather 
in the conversion of the elements of blood into the more 
solid tissues, nutritive diet, fresh air, cascarilla, cinchona, 
strychnia, cod-liver oil, and such other means as add to 
the tone of the general system, often prove of service. 
I have seen, also, marked good effects, under these cir- 
cumstances, from the use of salts of the peroxide of iron. 
The succinate of the peroxide is one of the best prepara- 
tions. But there are no fixed rules to direct the use of 
remedies in this condition, and the whole therapeutic 
course directed for its relief is, at best, but rational em- 
piricism. 

Two children, a brother and sister, the girl aged ten, 
the boy eight years, labored under rheumatic endocar- 
ditis of several months' duration . In both cases, a marked 
murmur was heard with the first sound of the heart, and 
increased impulse could be seen and felt as high as the 
second and third ribs. In the girl, the cellular tissue 
surrounding the eyes was generally more or less puffed, 
and in the boy, this congestion extended to all the capil- 
laries of the head and neck, particularly after slight 
exertion, when his complexion, usually ruddy, assumed 
a dusky hue. In both, moderate exercise gave rise to 



AND THE RHEUMATIC ELEMENT. 55 

palpitation and dyspnoea. The boy suffered also with a 
dry cough, and slight catarrhal fremitus could generally 
be recognized in his case. He complained frequently of 
fleeting pain in the left arm. The girl suffered occasion- 
ally with violent headache, when her face was always 
much flushed, and slight pressure over either the fibrous 
expansion of the temporal or occipito-frontalis muscles 
invariably caused much pain. The urine in both cases 
was often of a deep color, but, at the same time, furnished 
no particular indication for treatment. The tongue of 
each was very red, and the papillae unusually elongated, 
rendering these organs as rough as the surface of a nut- 
meg grater. The mucous follicles on the back wall of 
the pharynx, and about the roots of the tonsils, were 
very much enlarged, and stood out above the level of 
the common mucous surface. 

In these cases, colchicum and all the usual remedies 
for rheumatism were tried for more than three months, 
without improving in the slightest degree the condition 
of the heart in either case. Finally all the previous 
remedies were laid aside, and they were both treated for 
follicular disease (chronic follicular gastritis of Andral), 
with the very best and most unlocked for results. Under 
the exclusive use of bread and milk diet, and a pill before 
each meal (composed of nitrate of silver gr. vj ; extract 
of gentian 5j ; ext. of cicuta 5ss; ft. pil. xxx), the symp- 
toms began very soon to improve, and at the end of two 
months, under the continued influence of this treatment, 
they seemed perfectly relieved, with the exception of a 
very faint murmur, which can be still heard, with the first 
sound of the heart, particularly in the case of the boy. 



ILLUSTRATIVE CASES. 



The following eleven observations have been selected 
as presenting striking illustrations of the rheumatic law. 
The conclusions afterwards stated are deduced from an 
analysis of these and sixteen other carefully observed 
cases : — 

CASE I. 

THE MILDEST FORM OF SUBACUTE FIBROUS BRONCHITIS. 

January 4, 1852. Mr. McN., a clerk in a dry goods 
store, aged twenty, has had a very distressing cough and 
much headache for the last seven weeks, in spite of 
which he has been going about and attending to his 
duties as usual. After some exposure early in Novem- 
ber, he suffered for a day or two with general muscular 
rheumatism, and slight pain in the left ankle-joint. In 
a short time the pain and aching in the limbs passed 
off, and he was seized with a harsh dry cough, which 
has continued, with greater or less intensity, until now. 
He has taken several cough mixtures, by the advice of 
his physician, and within the past two weeks has re- 
sorted to the use of nostrums. 

Throat and pharynx healthy; pulse seventy; respira- 
tion fifteen; skin dry. No trace of anything wrong 
about the heart or lungs, except a faint sibilant rale on 



58 ILLUSTRATIVE CASES. 

the right side. Says it hurts him to comb his hair, and 
has tenderness over the broad tendon of the occipito- 
fron talis and the fibrous expansion of the left temporal 
muscles. The sensibility is marked, and exactly limited 
to the outline of these fibrous sheaths. 

bill. The urine, which has been rather more abundant 
for the past twenty-four hours than the normal quantity, 
is of a dark color, has a specific gravity of twenty-three, 
and is highly charged with crystals of uric acid and some 
urate of soda. He says that it varies very much, both 
as to quantity and color; that one day it is pale, and the 
next day dark. 

Directed him to take a warm bath every night at bed- 
time, and to avoid exposure to night air and damp days. 
R. Phosph. ammonia iss; aquae ^iv; add. ext. actaea 
racemosge Iss; syr. prunus Virginianas ^iv. M. S. A 
tablespoonful every six hours. 

Ibth. He failed to take the bath, but has used the 
prescription with the best effects, and has had no cough 
for the past three days. A number of cases similar to 
the above have been relieved, either by alkalies, citric 
acid, or extract of cohosh and warm bathing; one or more 
of these remedies having been advised as the appear- 
ances furnished by the urine seemed to indicate them. 



CASE II. 

SUBACUTE RHEUMATIC BRONCHITIS. 

D. B. R., aged thirty-eight, an officer in the United 
States navy, of hardy constitution and resolute character, 
had never been liable to attacks of any sort. On the 
15th of April, 1850, he came under my care, from Wash- 
ington, where, during a season of cold and damp weather, 



ILLUSTRATIVE CASES. 59 

he had often gone to his lodgings at night with wet feet, 
and, from much exposure, had contracted a harsh, dry, 
and unproductive cough, of about three weeks' standing. 
Auscultation recognized no trace whatever of anything 
wrong about the chest, in which he had no pain, except 
in the act of coughing, when he felt as if the "lungs 
were scraped with some rough instrument." The effort 
to take a long breath brought on a spell of coughing. 
Tongue white; pulse and respiration at a healthy stand- 
ard. He was informed that he had rheumatism affecting 
the bronchial tubes, and, in reply to this announcement, 
said : " I never was subject to anything of the sort in 
my life, and do not see how a man can have rheumatism 
without pain." His cough was most troublesome in the 
evening, and particularly so for an hour or more after 
going to bed. R. Phosphat. ammonise ^ss; aquce ^vj. 
M.S. A tablespoonful thrice daily. R. Vin. colchici ij. 
S. Take twenty-five drops with each dose of the solution. 
The following morning he sent for me, and remarked, 
as soon as I saw him, that he had been seized in the 
night with violent pain in the left shoulder-joint, and 
that he believed his rheumatism had been produced by 
talking and thinking about it. It was explained that it 
was merely a transfer of the disease to the shoulder-joint, 
in which the pain was so severe as to tie him down in 
bed, the slightest movement of the left arm being ex- 
tremely painful. The cough had, in a great measure, 
ceased. He passed a sleepless night, had considerable 
fever, with moderate heat of skin. Took from the arm 
some twelve ounces of blood, directed the colchicum and 
alkali to be continued, and ordered ten grains of calomel 
at bedtime. At the end of ten days the cough had 
entirely subsided, and the pain in the shoulder was quite 
relieved ; but there was probably some transfer of the 
rheumatic element to the fibrous theca covering the spi- 



60 ILLUSTRATIVE CASES. 

iial cord, since he continued to suffer for several months 
with fleeting pains, more or less severe — but differing 
from nerveache in being more diffused — in the head, 
shoulders, and limbs. During the following autumn he 
suffered less pain, but was troubled with great depression 
of spirits, amounting at times to absolute melancholia. 
This condition continued, with slight variations, until 
January, 1852, when he again came under my care. 
Seeing that his appetite, strength, and general health 
seemed good, it was difficult to decide what to do; but, 
remembering that his disease had its origin in rheuma- 
tism, and suspecting that this element might still be 
lurking, in a chronic form, about the tissues covering the 
spinal cord, I made an examination of his urine, and 
found it charged with a superabundance of earthy phos- 
phates; to correct which diathesis, I put him on the acid 
of one lemon daily. At the end of a month, he seemed 
to have improved little or none. He was then advised 
to take twenty grains of powdered cimicifuga thrice 
daily, and to continue the lemon acid. At the end of 
about another month, having carefully adhered to the 
remedies, he declared himself much better; which opi- 
nion was confirmed by the united testimony of his 
friends. When I last saw him, he was still taking the 
cimicifuga, to the use of which he was disposed to attri- 
bute his relief His condition, from some cause, was 
greatly improved ; indeed, he seemed to be perfectly well. 
Eemarks. — There is one point in this case worthy of 
special notice, which is, that so long as the rheumatic 
element remained, as it had done for more than two 
weeks, about the fibrous tissues of the bronchi, there 
was no marked symptom except the cough, and no indi- 
cation for active treatment; but when the metastasis of 
the disease took place, the cough declined, and pain in 
the shoulder came on, with heat of skin, and very 



ILLUSTRATIVE CASES. 61 

marked disturbance of the general circulation. The 
transfer took place without a renewal of the causes 
which were likely to augment the intensity of the rheu- 
matic law, which goes to show that a very acute rheu- 
matism may affect the bronchia without giving rise to 
much disorder in the general economy, or to symptoms 
affording a sure index of the necessity for depletion or 
other active interference, which the successful manage- 
ment of these cases so often requires. 



CASE III. 
ACUTE RHEUMATIC BRONCHITIS. 

A lady, unmarried, about thirty, of delicate figure but 
strong constitution, had always enjoyed uninterrupted 
good health, with the exception of an attack of typhoid 
fever, from the effects of which she had perfectly re- 
covered several years previous to the attack which is 
here recorded. Having endured much loss of rest, 
mental anxiety, and fatigue, while engaged in nursing 
a sick relative, besides being exposed, during a cold 
and inclement season, to the varying temperature of 
heated and cold apartments, she was attacked, on the 
6th February, 1849, with prolonged chilliness, scarcely 
amounting to rigors, follow^ed by the assemblage of 
phenomena which usually attend symptomatic inflam- 
matory fever. The only evidence of local disorder was 
a constant hard and dry cough, notwithstanding wdiich 
auscultation discovered nothing about the chest except 
a faint isolated and occasional sibilant rale over the 
dorsal surface of one or both lungs. From the 14th of 
February to the 7th of March, a rattle, variable as to 
size, dryness, and abundance, could be uniformly heard 



62 ILLUSTRATIVE CASES. 

on the right side, over a diameter of about two inches, 
the centre of which was about one inch and a half below 
the inferior angle of the scapula. At this point, accu- 
rate comparison with the opposite side could detect 
neither increased dulness, vocal resonance, nor fremitus, 
at any time. Every other part of both lungs seemed 
perfectly healthy, except that throughout this very pro- 
tracted acute attack a sibilant rale could be often heard 
over the scapular region of one or both lungs. The 
cough was generally dry and unproductive, except that 
now and then a small quantity of extremely viscid mucus 
was voided, mingled occasionally with small quantities 
of albuminoid serum, and, floating on this, a highly 
aerated sputa, resembling the white of eggs when beaten 
into whips. One of the most constant and annoying 
symptoms was the irregular occurrence of the most 
copious and exhausting sweats, which happened three 
or four times in the twenty-four hours, during the night 
or day, through the entire course of the disease. The 
pulse ranged from ninety-five to one hundred and sixty, 
and the respiration, at times irregular, was often found 
as high as fifty-five in the minute. The patient com- 
plained throughout of extreme sensibility to the im- 
pression of cold, the least exposure of the hands, face, 
or neck, to the air of the apartment, which was about 
70° Fahr., causing her to complain of chilliness. This 
was probably owing to the very free sweating, which 
caused rapid evaporation from the surface. The urine 
was uniformly small in quantity, had the color of dark 
brandy, and contained, at every examination, urate of 
soda, and a large excess of uric acid. This case was 
treated by free depletion, both general and local; the 
blood, which cooled at a temperature of about 64°, 
showing an unusual amount of the buffy coat, especially 
that which was drawn late in the disease. She was kept 



ILLUSTRATIVE CASES. 63 

constantly under the influence of compound nitrous 
powders, antimony, or nauseating doses of ipecacuanha. 
Prussic acid and digitalis were unavailingly used to con- 
trol the heart's action, and, towards the last, aromatic 
sulphuric acid was resorted to for the purpose of preventing 
the very copious sweats. This treatment was instituted in 
accordance with the advice of two physicians, deservedly 
eminent in the profession. Seeing that the case was diffi- 
cult and dangerous, the skill and experience of these 
gentlemen had been called in requisition early in the 
disease. Finally, on the night of the 7th March, our 
patient labored under delirium, had cold extremities, an 
extremely rapid respiration, and a pulse of one hundred 
and fifty-five in the minute, and excessively weak. The 
powers of life seemed to be failing rapidly; the skin was 
bathed in a cold sweat; the face, which had been uni- 
formly more or less flushed, became pale, and the counte- 
nance anxious, with a sharp or pinched look about the 
features. The prognosis was that our patient w^ould die 
before morning. The dorsal decubitus, and other evi- 
dences of nervous prostration, showed that she was too 
weak to bear depressing agents; and, indeed, a stimulant, 
in the form of weak wine whey, had already been resorted 
to. At this juncture, the rale still existing as it had at 
first been noticed, at the base of the right lung, and a 
murmur having been observed for the past two days, 
synchronous with the second sound of the heart, it w^as 
suggested, for the first time, that this might be a case of 
rheumatic bronchitis, that the rheumatic element had 
beset the heart, and that, as the urine was charged with 
uric acid and urate of soda, benefit might result from 
the use of some alkali. 

Both of the gentlemen before referred to, to their 
honor be it said, were too thoroughly versed in the 
practical and theoretical doctrines of their profession, 



64 ILLUSTRATIVE CASES. 

and too loyal to the established principles of the best 
authorities, to admit for a moment any such proposition. 
They believed that an old gouty or rheumatic subject 
might be troubled with a symptomatic cough, but an 
acute idiopathic, fibrous, or rheumatic bronchitis, was 
something they did not comprehend, and the existence 
of which they were not prepared to admit; but, as an 
alkali could do no harm, they did not object to the 
trial. Accordingly, all other remedies being laid aside, 
the patient was put on twenty grains of the bicarbonate 
of potassa every three hours. The following morning, 
eighty grains of this salt having been taken, we found 
our patient better. She had slept considerably, the 
respiration was calmer, and the pulse had fallen to one 
hundred; but the auscultatory signs at the base of the 
right lung, and the murmur with the second sound of 
the heart, remained unaltered. The urine being scanty 
and high colored, it was agreed to change the bicarbonate 
of potassa for the phosphate of ammonia, which latter 
was directed in doses of fifteen grains every four hours. 
Having continued this treatment until the 11th, all the 
general symptoms had vanished. The pulse and respi- 
ration had resumed their healthy standard, the sweats 
had entirely ceased, and careful inspection of the chest 
could detect no trace either of the murmur with the 
first sound of the heart or the crepitant rale at the base 
of the right lung. All drugs were discontinued, and the 
patient pronounced fairly convalescent. 

But the point of greatest importance, and of most 
interest, so far as the etiology of this disease is concerned, 
remains to be noticed. This lady, having been convales- 
cing for three days, complained, on the night of the 14th 
of March, of slight chilliness, followed by fever and 
sweating. On examining the base of the right lung, no 
trace of either moist or dry sounds could be heard over 



ILLUSTRATIVE CASES. 65 

ths point where they had so long persisted, and from 
which they had been absent only three days; but, from 
a point about three inches higher up, and from thence to 
the spine of the scapula, over an irregular space of from 
two to three inches in diameter, fine and coarse crepitant 
and subcrepitant rattles were distinctly heard. These 
sounds, confined to the limits of their new situation, were 
well marked the following day, but soon disappeared 
under the use of the alkali, which was continued for 
several days, rendering the urine light-colored and very 
abundant. 

Re:marks. — A point of much interest in this case is 
the happy influence exerted hy the use of alkalies, ex- 
hibited even at the ninth hour, and the ejQfect these simple 
agents had in controlling the uric acid diathesis, and 
thereby dissolving out and removing the irritant or 
splinter from the seat of the disease. 

But the point of most importance is, that the pneu- 
monia, having changed from the third or lower to the 
middle lobe of the right lung, furnishes actual proof of 
the metastatic character of the disease, and that a trans- 
fer of the inflammatory process may take place from one 
portion of the fibrous tissue of the bronchi to another, 
just as it is so often observed to do in like structures of 
the body generally. The cardiac murmur, which must 
have originated from the bronchitis, shows also, very 
clearly, the rheumatic character of the disease. 

CASE lY. 

chronic fibrous or rheumatic bronchitis, of five 
months' standing. 

April 10, 1849. J. M., a little girl, born of healthy 
parents, and aged nine years, attends one of our public 
5 



66 ILLUSTRATIVE CASES. 

schools. After exposure to rain, some time in October 
last, she went home, and remained in her wet clothes. 
The following day she was attacked with fever and 
cough, which confined her to bed for five weeks, during 
which period she was treated for the "catarrh fever." 
After she left her room, the cough still continued, and, 
the fever returning, she was again laid up. This hap- 
pened some three or four times, the least exposure, par- 
ticularly to damp air, augmenting the cough and renewing 
the fever, so that she has been confined to her bed during 
most of the winter. She has been taking, for the past 
five weeks, cod-liver oil, by the advice of her physician, 
who at last concluded that her case was tubercular 
phthisis, as well he might, from the general symptoms. 
She has circumscribed rosy spots in both cheeks, fever 
in the evening, followed by night-sweats, a deep and 
constant cough, somewhat metallic in its character, and 
producing a tolerabty abundant mucous sputa, mingled 
with a frothy and very viscid serum. She is greatly 
emaciated and extremely feeble, the slightest exertion 
producing dyspnoea. Pulse and respiration very variable 
as to frequency, the one averaging perhaps twenty-six, 
and the other about ninety-five. Bowels regular ; urine 
of a pale straw color, except in the morning, when it 
often deposits a reddish sediment. 

Inspection of the chest detects flatness, with less 
active expansion on the right than the left side. Thrill 
felt on palpation nearly alike on the two sides, but vocal 
resonance greatly in favor of the left lung, over which 
latter the respiration is everywhere even and clear, but 
excessively exaggerated or puerile in its character. On 
the right side, coarse crepitant rattle, very metallic in 
sound, from the clavicle to the fifth rib, and from thence 
to the base • of the lung, on its anterior surface, the ve- 
sicular murmur is healthy, but feeble in character, and 



ILLUSTRATIVE CASES. 67 

mingled with some subcrepitant rattle. Crepitant rattle 
is also heard over the axillary region, where it is mingled 
with a coarse ronchus, and from the summit of the Inns', 
on its posterior surface, to the inferior angle of the scapula, 
below which line, on the lateral as well as the dorsal 
regions, there is abundant subcrepitant rattle. Reso- 
nance, on percussion over the left lung, much greater, 
and on the right side rather less than normal; the differ- 
ence in this respect being most marked above and a short 
distance below the clavicles. Slight alteration in the 
rhythm of the heart, and a low rough murmur synchro- 
nous with the second sound. R. Phosph. ammonias ass; 
aqu^ 3vj. M. S. A teaspoonful every six hours. R. Yi- 
ni colchici sij. S. Twenty drops with each dose of 
the solution. B. Syr. ferri iodidi ^ij. S. Twenty drops 
thrice daily, in water. These remedies to be given 
alternately for three days, commencing with the alkali 
and colchicum. 

It is to be regretted that no record was kept of the 
successive steps in the progress of this case to a favor- 
able termination, farther than that the above remedies 
were given to the exclusion of any other agents, changing 
them every third day, until the middle of June, when 
the cough had entirely ceased, and the general health 
seemed to be perfectly restored. In the winter of 1850 
this child had a return of cough, attended by fever and 
sweating. The mother having kept the phials, had 
them refilled by the apothecary with their former con- 
tents, which she gave w^ith the same happy results. 

During the past spring of the present year (1852), I 
attended this same child, now about twelve years old, in 
an attack of acute rheumatic sclerotitis and vascular 
keratitis of the left eye. In this last attack, the urine 
furnished no single indication for treatment. In spite 
of free depletion from the arm. rigid diet, numberless 



•68 ILLUSTRATIVE CASES. 

doses of calomel and nitre, repeated blisters to the nape 
of the neck, the use of alkalies and citric acid, the in- 
flammation, attended by extreme photophobia, held out 
with the greatest pertinacity for more than two months. 
The little patient was at last greatly benefited by taking 
sulphate of quinia and bicarbonate of soda, combined; 
wdiicli remedies were given at the suggestion of Dr. A. 
DuBois. Finally, the inflammation left the eye, with a 
point of thickening on the sclerotica, about the size of a 
flattened millet-seed, between the inner canthus and the 
cornea, in which latter, were two small nebulous deposits. 
It may be well to add, that there was slight vascular 
keratitis, but little or no conjunctivitis in this case, and 
no ulceration of the cornea, and that astringent and 
anodyne collyria were not resorted to in the way of local 
treatment, nothing having been used but repeated warm 
bathing, applied from a basin with the hand, the eye 
being closed, 

CASE V. 

ACUTE FIBROUS BRONCHITIS, WITH SYMPTOMATIC PNEUMONIA, 
ENDO-PERICARDITIS, AND, FINALLY, A TRANSFER OF THE 
, RHEUMATIC ELEMENT TO THE THECA VERTEBRALIS. 

Mrs. B., a lady in affluent circumstances, aged about 
fifty, of fair complexion and rather delicate figure, has 
always enjoyed uninterrupted good health, with the ex- 
ception of occasional attacks of dyspepsia, which were 
invariably relieved by the use of the Saratoga waters. 
About September last, this lady, in the enjoyment of her 
usual good health, went to West Point. On her return 
home, while in New York, she rode several miles in an 
open carriage, and, not being adequately provided with 
wrappings suited to the coldness of the day, suffered much 



ILLUSTRATIVE CASES. 69 

from exposure to a damp air. After returning to her 
lodgings in the city, she experienced a sense of chilliness, 
accompanied by pain in the region of the stomach. On 
the day following (October 2), notwithstanding a feeling 
of great indisposition, she came as far as Philadelphia, 
where she consulted a medical gentleman, who regarded 
her attack as one of influenza, an epidemic of which was 
prevailing at the time. On the 6th, observing that the 
sputa were slightly rusty, he examined the chest, and 
recognized unequivocal signs of pneumonia, occupying a 
space about the size of a dollar, over the middle of the 
lower lobe of the left lung, on its dorsal surface. As the 
engorgement was very limited in extent, and attended by 
very mild general symptoms, her physician made use of 
a gently antiphlogistic course, which, together with mild 
anodynes, relieved her condition so far that, on the 12 th, 
she felt 'herself well enough to return home, and accord- 
ingly set out by steamboat for Baltimore. I saw her, for 
the first time, on the loth, at her summer residence, 
three miles, in a north-western direction, from this city. 
She was extremely restless, and complained much of a 
general but undefined sense of distress. Pulse ninety- 
six; respiration twenty-one. Over a diameter of about 
two inches, on the posterior face and about the centre of 
the left lung, a coarse crepitant rattle, such as occurs in 
resolvent pneumonia, was heard, mixed up with some 
subcrepitant and an occasional sibilant rale; also, slight 
dulness on percussion, compared with the corresponding 
point on the right side. Suspecting, from the persistence 
of these signs, which had now lasted for thirteen days, 
that this might be a case of rheumatic bronchitis, I put 
my ear over the heart, and discovered a very marked 
murmur with its first sound. She assured me that she 
had not experienced the slightest uneasiness over the 
praecordial region. Seeing that she had fibrous bronchitis, 



70 ILLUSTRATIVE CASES. 

with symptomatic pneumonia and endocarditis, her case 
was pronounced dangerous. R. Bicarb, potass, .^ss; acid, 
hydrocyanic. fn.xij; water ^vj. S. A tablespoonful every 
four hours. 

19 til. She was seized the night previous with a very 
acute pain in the region of the heart, extending in the 
direction of the xiphoid cartilage. Pulse ninety-five, and 
intermittent ; respiration irregular. Advised a sinapism 
to the chest. R. Phosphate of ammonia gss, water gvj. 
Make neutral by adding carbonate of ammonia, and 
give a tablespoonful every six hours, with twenty-five 
drops of wine of colchicum at each dose. 

20tJi. Still much pain in the region of the heart, with 
tenderness on pressure over the intercostal spaces. Mur- 
mur with the first sound less distinct; marked pericardial 
friction over the middle third of the sternum. Pulse 
more irregular than yesterday. Constant nausea, with 
eructations of wind and efforts to vomit. Ordered twelve 
leeches to be applied along the left margin of the sternum, 
and ten grains of calomel at bedtime. 

22d. She is disposed to sit up in bed; little or no pain 
in the chest; cough hard, dry, and unproductive; sto- 
mach so irritable that she can retain nothing on it. 
Ordered an epispastic over the heart, and a drop of hy- 
drocyanic acid every three hours. The blistered surface 
to be dressed with an ointment of iodide of potassa. 

The foregoing symptoms continued, with varying de- 
grees of intensity, until the 30 th, when she was moved 
to her residence in the city. 

Nov. 3. Pulse small, frequent, and very intermittent. 
Both sounds of the heart muffled and indistinct. Con- 
siderable dulness on percussion over the prsecordial region. 
She can only breathe with comfort when she sits up in 
bed, with the body bent forward, and the head supported. 
Some moist crepitant rale at the base of both lungs. 



ILLUSTRATIVE CASES. 71 

Sliglit sibilant and subcrepitant rale at the point at 
first described, over the lower lobe of the left lung, in 
which place the moist sounds have varied from day to 
dav. At one visit a crepitant, and at another time a 
subcrepitant rale was heard; while on other occasions 
these sounds were mingled, and then again both were 
absent, and nothing could be heard at that point but a 
faint sibilant rale. Apprehending, at this stage of the 
case, death from effusion into the pericardium, she was 
put on diuretics and hjdragogue cathartics. 

\2th. She was seized at night with pain in the back 
and about the left scapula; and a sister, to whom she 
beckoned, on going to the bed, found that she was unable 
to articulate a single word. Some thirty-six hours after 
this seizure, complete paralysis of the nerves of motion 
supervened on the left side only, but without loss of 
sensibility. She remained without material change in 
her condition until the 5th of the next month, and 
then she lapsed into profound coma, which continued 
until the 7th, when she expired. 

The medical gentleman who attended this lady in 
Philadelphia says, in a note, that he did not examine 
her heart, there being no general symptoms leading him 
to suspect mischief in that seat. It would seem, then, 
in this case, that the rheumatism commenced in the 
fibrous tissues of the left bronchi, from whence it was 
transferred to the mitral valve, that next the pericardium 
became involved, and lastly, that a metastasis of the 
morbid element took place to the arachnoid covering of 
the spinal theca and dura mater. And, moreover, it 
should be remembered that the inflammation affecting 
the fibrous tissue of the bronchi was propagated to the 
parenchyma of the lung, giving rise, early in the disease, 
to a local subacute pneumonia, which continued, with 
varying intensity, throughout the attack. 



72 ILLUSTRATIVE CASES. 



CASE YI. 

IDIOPATHIC RHEUMATIC BRONCHITIS, TTITH SYMPTOMATIC PNEU- 
MONIA, ENDOCARDITIS, AND INDUCED PHTHISIS. 

The following case has been given in detail, because 
it was found impossible to convey intelligibly the nu- 
merous points of interest in a more condensed form, and 
especially to present them in the chronological order of 
their occurrence. 

W. E. v., a merchant, aged forty-two, of sinewy and 
slender figure, and having no hereditary predisposition 
to disease, has alwaj^s led an active life and experienced 
excellent health, with the following exceptions : — 

In the winter of 1839, he had an attack in which he 
labored under a severe cough, attended by fever, which 
confined him to bed for six weeks ; having been actively 
treated, he recovered perfectly. In the spring of 1844, 
he had a bad cough, which lasted for three months, but 
did not confine him to bed. And again, in the winter 
of 1848, he placed himself under my care, during an 
attack of rheumatic bronchitis and pneumonia, which 
lasted about five weeks. In the intervals between these 
different seizures, he lost his cough, and seemed to enjoy 
the most perfect health. 

Ajml 5, 1852. Mr. Y. called at my office, and in- 
formed me that his health had been as good as usual 
until the previous Saturday (the od), when he went 
from a furnace-heated room to the funeral of a friend, 
where he was much exposed to cold and damp air, be- 
sides getting his feet wet. The next day he had sore- 
ness and aching in his limbs, and some cough, but did 
not remember to have experienced anything like a chill. 



ILLUSTRATIVE CASES. 73 

The pain and soreness in his limbs had, in great measure, 
passed off, but the cough was more troublesome. He 
had dryness of skin, and a slightly coated tongue, but 
no fever. Inspection of the chest detected nothing 
wrong except a slight sibilant rale and faintness in the 
vesicular murmur on the right side. Directed for him 
an anodyne and antimonial cough mixture. 

Sth. Having been sent for, I find Mr. V. sitting up in 
his chamber, a high and dry room, comfortably warmed 
by a blazing open wood-fire. Cough hard and dry, but 
not very constant. Complains that he could get no 
sleep, and thinks he must have had fever during the 
night. Slight pufiiness around the eyes; skin dry; 
tongue white; some appetite, no thirst; bowels costive; 
urine normal in quantity, high colored, and somewhat 
turbid; pulse seventy-two, open, soft, and regular. 
Sounds, rhythm, and impulse of heart perfectly healthy. 
Faint sibilant rale on the right side. Directed him to keep 
at rest, and take a dose of Henry's calcined magnesia. 

9t7i. Signs unchanged. The urine voided yesterday 
exhibits, under the field of a microscope, granular urate 
of soda in great quantity, and a few crystals of uric 
acid. B. Ext. actaea racemosge 5ss; spt. nit. dul- 
cis *^; syr. prunus Virginianas et aquae aa "§1^.3^. 
M. S. A tablespoonful every six hours. - Under the in- 
fluence of these remedies, he continued to improve until 
the 16th, when he felt so well that he left his room and 
w^alked to his store, the day being rainy, and the air 
very damp and raw. On the following morning he felt 
much worse, and was again confined to his house. 

IStJi. In bed, laboring under considerable fever; tongue 
white; great heat of skin, and much thirst; had a copious 
sweat, and lost much sleep the night previous. Kespi- 
ration eighteen, pulse one hundred and ten. Some head- 
ache, anorexia, slight nausea, cough harassing, with some 



74 ILLUSTRATIVE CASES. 

expectoration of a highly albuminoid serum, mingled 
with small mucous flakes. Slight catarrhal fremitus, and 
some coarse subcrepitant rfde at the base of both lungs. 
Bowels constipated; urine scanty, and very high colored. 
Resume the cohosh mixture ; take an ounce of Rochelle 
salts and a drop of hydrocyanic acid every three hours. 

20/A. Discover a slight roughness at the beginning of 
the second sound of the heart. The sweats still very 
profuse; urine small in quantity, and highly charged 
with crystals of uric acid and irregular particles of urate 
of soda. Stop the previous remedies. To take ten 
grains of calomel at bedtime, and twenty grains of 
phosphate of ammonia every six hours. 

21st. Has had five stools, preceded by slight tormina, 
and attended with considerable tenesmus. General 
symptoms and auscultatory signs unchanged. 

23c/. Cough paroxj^smal and very dry; tongue white; 
bowels costive; copious sweating; urine scanty, and 
deposits an abundant f\iwn-colored precipitate. R. Sub- 
mur. hj'dr. gr. xxv; nit. potass, jij; pulv. ipecacuanhaB 
9ij; in chart, xij. S. One every three hours. 
• 26 fJi. Respiration twenty-four, pulse one hundred and 
twenty. Cough short and hacking; sputa rusty, small 
in quantity, and much aerated. Profuse sweating. 
Tongue, having been uniformly white and moist, is now 
covered with a dry brown coating. On the left side of 
the chesty a fine dry crepitant rale is heard from the 
spine of the scapula to a point a little below its inferior 
angle, over which region there is greater vocal resonance, 
tubal respiration, thrill on palpation, and dulness on 
percussion, than at corresponding points on the right 
dorsal surface. No longer roughness with the second, 
but marked murmur with the first sound of the heart. 
He is bathed in a profuse sweat, and complains of 
great prostration, which he attributes to the copious 



ILLUSTRATIVE CASES. 75 

perspirations, but which is most likely owing to the 
shock inflicted on the nervous system by the occurrence 
of the engorgement. He manifests the most inordinate 
sensibility to cold, desiring, when he turns on his side 
and exposes the back of his neck, that the bedclothes be 
drawn close about his throat and head. He will not 
allow his hands or any part of his surface to be un- 
covered for a moment. Notwithstanding these copious 
sweats, he has burning about the soles of his feet, which 
feel very dry and parched. Have taken twenty-five 
ounces of blood from the arm, ordered a hot foot-bath, 
and directed a continuance of the previous remedies. 

2^th. Fine dry crepitant rale is still heard over the 
dorsal surface of the left lung, mingled with a coarse 
crepitus. The blood drawn yesterday is covered with 
a thick and remarkably firm bufiy coat, and shows 
unusual precipitation of red globules. Sweating still 
very profuse. He suffered during last night, and now 
has distressing strangury, and makes repeated efforts to 
pass a very small quantity of highly-colored urine, which 
is largely charged with phosphates and lozenge-shaped 
cr3^stals of uric acid. Continue treatment. 

2^tli. Strength improved; no movement of the bowels 
for several days. Complains of pain about the umbilicus. 
Fine dry and coarse crepitant rale and a sniffling respi- 
ration are heard over the lower two-thirds of the left 
lung, on its dorsal surface; marked bronchial respiration 
and bronchophony, with increased thrill on palpation. 
Murmur with the first sound of the heart more marked. 
Pulse ninety-five, respiration eighteen. Continue nitrous 
powders, omitting the calomel; give the alkali as usual, 
and a purgative enema. 

oO^A, morning. Eespiration twenty-eight; pulse one 
hundred and four ; quicker in its throb, and less com- 
pressible. The ear can no longer detect fine crepitus. 



76 ILLUSTRATIVE CASES. 

but moist ronchi are heard here and there, especi- 
ally when a deep breath is taken; vocal resonance, 
fremitus and dulness on percussion more marked, show- 
ing that a considerable portion of the lung has lapsed 
into the second stage. Urgent thirst, skin moist, face 
hushed, tongue covered with a heavy brown coating. 
Have taken fifteen ounces of blood from the arm, and 
directed the treatment to be continued. Evening. Blood 
drawn this morning is very much cupped and covered 
with a dense buff, measuring about one-third of the 
entire thickness of the clot, which can be taken by its 
edge and lifted from the bowl without breaking. Aus- 
cultatory signs unchanged ; respiration twenty-four ; 
pulse has not varied since the morning either in force 
or frequency. R. Vin. colchici ^iss; tinct. digitalis 
5SS. S. Give thirty drops, with a dose of the alkaline 
solution, every six hours, and continue the other agents. 
May 1. General condition and auscultatory signs 
unchanged. Pulse one hundred and one; respiration 
twenty-two. Urine the color of port wine, and charged 
with uric acid crj^stals, having the form of truncafed 
columns, and the appearance, under the field of the 
microscope, of plates having parallel lines. Dr. David 
Stewart, who is very familiar with the various appear- 
ances presented by urinary deposits, saw this specimen. 
He says that he has only met wdth one or two examples 
of this form of uric acid. Golding Bird has described 
this peculiar crystalline arangement as having occurred 
in a speciruen of urine which had been treated with 
urate of soda and acetic acid. Not only the sample of 
urine taken on the 1st May, but other specimens, when 
evaporated to dryness, left on a plate of glass a white 
semi-transparent salt, disposed in closely-set lines, cross- 
ing each other generally at right angles, but forming 
occasionally, at their points of union, acute and obtuse 



ILLUSTRATIVE CASES. 77 

corners. I at first supposed them to be an amorphous 
distribution of muriate of soda, but, comparing them 
with precipitates of this salt, it was easily seen that this 
could not be the case ; and, on adding a little phosphate 
of soda to the solution of table salt, the crystalline ar- 
rangement above described at once appeared. It is pro- 
bable, then, that the precipitate in question was a im^¥^- cLoiaM^ 
Boopio ' salt, composed of muriate and phosphate of soda 
combined. The existence of urate of soda in the blood 
having been established, the above appearance goes far 
to prove the truth of the theory proposed some time 
since as to the supposed action of phosphate of ammo- 
nia. It will be remembered, when this agent was pro- 
posed as a remedy for rheumatism, that the theory of 
its action was believed to be that it converted urate 
of soda, which the skin and kidneys cannot void, into 
two soluble salts — urate of ammonia on the one hand, 
and phosphate of soda on the other, both of which are 
very soluble and readily eliminated, the one by the 
skin, and the other by the kidneys. Continue treat- 
ment. 

May 3. Has had a refreshing sleep of some hours. 
Tongue moist and cleaning ; skin moist without sweat. 
Pulse seventy- two ; respiration fourteen. Abundant 
coarse crepitant rale of resolvent pneumonia on the 
dorsal surface of the left lung. Urine more abundant, 
but no less turbid, and of a dark mulberry color. Ee- 
duce the dose of colchicum and digitalis to ten drops. 
Divide the nitrous powders into four parts, and give 
one of these at the usual intervals. Discontinue the 
alkaline draught. 

^tli. He has had a refreshing sleep, and seems fairly 
convalescent. No thirst, but considerable appetite, and 
craves something salt. With an easy cough he gets up 
a small quantity of non-aerated semi-opaque bronchial 



78 ILLUSTRATIVE CASES. 

mucus. Tongue cleaning ; pulse sixty-eight ; respira- 
tion fourteen. Fremitus, bronchial resonance, and dul- 
ness on percussion greatly lessened. Redux crepitant 
rale from the spine of the scapula to the base of the 
left lung. Murmur with the first sound of the heart 
scarcely perceptible. Stop all medicine, and give beef- 
tea and chicken-broth. 

6^'^. Having, on the morning of the 5th, placed Mr. 
V. under the care of a friend, I left town until this 
morning, when I find my patient in the same improving 
condition, the physician reporting no unfavorable change. 
He has taken no medicine since the morning of the 4th, 
except one or two doses of colchicum and digitalis, and 
an enema of warm salt and water. 

1th. Eeceived a message from him this morning, stat- 
ing that he was very ill. Finding him laboring under 
violent nephralgia of the left kidney, over which there 
is extreme sensibility to pressure, pain along the course 
of the ureter, some irritability of bladder, and slight 
strangury. The pain came on about ten o'clock last 
evening, and increased as the night advanced. He has 
entire suppression of urine, not having voided any since 
yesterday. No distension of bladder. He ate yesterday, 
for the first time since his attack, a quantity of ice, and 
drank some ice-water, but, having very little thirst, {he 
whole quantity of fluid taken was much less than on 
any previous day. He slept last night for the first time 
without fire in his room, but it is believed that the tem- 
perature did not fall below 68°. Says that the enema 
which he took last night felt cold in his bowels, and 
that his clothes were wet during the exhibition of it. 
All of these causes may have contributed to depress his 
nervous system and arrest the action of his skin. Sup- 
posing that the nephralgic condition may arise from 
insufficiency of water in the blood to dissolve the excess 



ILLUSTRATIVE CASES. 79 

of salts while in the act of being secreted by the kid- 
neys, and that crystals may have formed in the tubulae 
uriniferi, and there excite irritation and consequent 
congestion, he is advised to take warm diluent drinks ; 
to apply cloths, wrung out of hot water, to the abdomen, 
and have cups applied over the region of the kidney. 

Noon. The remedies have afforded no relief. Blood 
shows no indication of buff. A few drops of urine, 
passed during the morning, are found to contain the 
granular urates of soda or lime in great abundance, and 
some crystals of uric acid. Twenty grains of phosphate 
of ammonia every four hours. 

Evening. Pulse one hundred and twenty ; respiration 
twenty-four. He has had a very free evacuation of 
amber-colored and very turbid urine. The pain and 
tenderness over the region of the kidney are quite re- 
lieved. At five o'clock this evening, he was seized with 
severe pleurodynia a little below the left nipple ; he 
finds it impossible to take a long breath, and complains 
of fleeting pain in the direction of the humero-intercos- 
tal nerve. R. Sol. sulph. morph. (Magendie's) n^^xv; 
spt. £eth. sulph. C. 3j ; aquas ^j. M. S. At one dose. 
Continue the alkali, and apply a sinapism over the seat 
of pain. 

StJi. Has passed a restless night; cough short, sup- 
pressed, and frequent; sputa sanguinolent, orange-color- 
ed, and slightly aerated. Complains still of pain in the 
side, with inability to take a full inspiration. Pulse 
one hundred and twenty-eight ; respiration twenty-six. 
Fine dry crepitant rale of pneumonia below the spine of 
the scapula and over the lower border of the axillary 
region. Continue alkali, and resume the colchicum and 
digitalis in doses of thirty drops every six hours. 

9th. Pain along the inferior margin of the pectoral 
muscle. Pulse one hundred and twenty-six ; respirar 



80 ILLUSTRATIVE CASES. 

tion twenty-two ; face flushed ; eyes bright ; voice feeble 
and tremulous; tongue coated and very dry. Apply 
cups over the seat of pain. R. Calomel 9j ; pulv. 
ipecac. 5ss; potass, nit. iij. Ft. chart, xij. M. S. Give 
one every three hours, and continue previous remedies. 

lOtJi. Has passed a quiet night. Pulse one hundred 
and twenty; respiration twenty-four. Feels no pain, 
except at the end of a deep inspiration. Profuse sweat- 
ing, bowels constipated, urine very dark-colored. Mur- 
mur with the first sound of the heart more marked and 
prolonged. Tactile fremitus, dulness on percussion, 
and vocal resonance very marked over the lower third 
of the lung, on its dorsal surface. Over the inferior 
axillary region, the resonance is bleating in its character, 
dulness on percussion absolute, and palpation detects 
no trace of vocal thrill. These last signs go to show 
that the suspected pleurodynia was in fact pleurisy. 
Continue treatment, and give an enema. 

11th. No material change. Continue treatment. 

12th. Some bubbles of crepitant ronchus over the dor- 
sal surface of the lung. Pulse ninety ; respiration six- 
teen. Constant nausea, and sometimes vomiting; one 
stool. Reduce the nitrous powders to one-half, and pro- 
long the interval to six hours. Panada, eight parts; 
wine, one part ; give a wineglassful every three hours, 
besides his ordinary diluent drinks. 

13th. Tongue moist and clean; much sweating. Pulse 
seventy; respiration fourteen. Coarse crepitant ron- 
chus more abundant on the posterior surface of the 
lung. In other respects, the actual and comparative 
state of the signs, both auscultatory and tactile, over 
both the dorsal and lateral regions, remain unchanged, 
except that the dulness on percussion and absence of 
vibration indicate a greater quantity of pleuritic efFu- 



ILLUSTRATIVE CASES. 81 

sion, encroaching now on the infra-scapular region. 
Reduce the dose of colchicum and digitalis one-half. 

14ith. Has passed comparatively a good night. One 
large and very fluid stool; profuse sweating. Pulse 
eighty, respiration fourteen. Abundant fine and coarse 
crepitant ronchus over the dorsal and lateral regions on 
the left side, notwithstanding which he has coughed but 
little, and expectorated only a very little non-aerated 
viscid mucus; indeed, throughout the attack, the amount 
of sputa has been very much less than might have been 
expected from the degree of cough and the abundance of 
moist sounds. Continue treatment. 

15/7i. Some sudamina have made their appearance 
above and below the clavicle, over the abdomen, and on 
both flanks. Notwithstanding the temperature of the 
room is 73° without fire, he manifests great sensibility 
to cold on the slightest exposure of his person, and begs 
to have a shawl thrown around him whenever he is raised 
or turned in bed for the purpose of examining the dorsal 
surface of his chest. Apply a blister 6x8 in. to the left 
lateral region of the thorax, and dress the blistered sur- 
face with an ointment of iodide of potassa. 

18//i. Pulse sixty-eight, respiration fourteen ; profuse 
sweating, anorexia, and vomiting, proceeding rather 
from sedation than from gastric irritation. Stop the 
nitrous powders, digitalis, and colchicum. Give dilute 
sulphuric acid, ten drops every six hours. 

22c?. He has passed a very restless night, and com- 
plains this morning of oppression about the chest, and a 
feeling of great exhaustion. Expression of eyes dull, 
pupils dilated, but respond readily to light; skin moist; 
extremities cool. Pulse one hundred and six, and very 
feeble; respiration twenty. Murmur with the first sound 
of the heart unchanged. Abundant moist sounds over 
6 



82 ILLUSTRATIVE CASES. 

the dorsal surfiice of the left lung, where the vocal reso- 
nance and thrill to the hand have undergone no dimi- 
nution. Absence of vibration, and extent of absolute 
dulness on percussion over the lateral region, indicate a 
greater quantity of pleuritic effusion. This morning, 
after a violent and long-continued paroxysm of cough, 
in which the nurse says he nearly strangled, he got up 
a plug of concrete mucus and albumen, covered on its 
outer surface with what seemed to be semiorganized 
plastic lymph. It is about an inch and a half in length, 
bears the appearance of having been retained for a long 
time, and must have been moulded in one of the primary 
bronchi. R. Carb. ammonise jij ; gum. acacise Jj ; aquae 
menthae §vj. M. S. A tablespoonful every three hours. 
Rub his whole surface with dry mustard, and give strong 
coffee and wine-whey. 

23c?. He is very desponding, and thinks his case hope- 
less. Emaciation excessive ; has slept three hours during 
last night. Muscles of the face relaxed, giving to his 
countenance a combined expression of innocence and 
dejection. Continue treatment, and let him take occa- 
sionally through the day a sip of mint-julep, made with 
good old brandy. 

24/7i. Strength and general condition improved. Stop 
the carbonate of ammonia. B. Strychnise gr. ij; acid, 
acetic. 5j; aquae destill. |j. M. S. Ten drops every 
eight hours. 

26/A. Appetite improved; auscultatory signs unchanged. 
Continue treatment, and give black tea and chicken-broth 
in addition to his other diet. 

21 th. Has slept the entire night, and says he feels 
much better. So great has been his sensibility to cold 
and fear of being chilled, that this is the first day he has 
allowed his hands to remain for a moment outside of the 
bedclothes.- Little or no sweating; bowels constipated. 



ILLUSTRATIVE CASES. 83 

R. Bitart. potass. 3J; chart, iv. One every six hours 
until the bowels are moved. 

2Sth. No action of the bowels. Give a purgative 
enema, and continue previous treatment. 

June 1. Strength, appetite, and general condition 
greatly improved. Tongue moist and clean ; pulse 
ninety, respiration sixteen. Cardiac murmur with the 
first sound less prolonged and audible. From the spine 
of the scapula to the base of the left lung the vocal 
fremitus and dulness on percussion have within the last 
few days lessened very much. The sound on percussion 
is manifestly clearer at one or two points than over the 
rest of the dorsal surface. This would seem to indicate 
that the pneumonia is clearing up in irregular patches. 
There having been so little secretion, the engorgement 
must have been taken up by absorption. Signs indicate 
a greater amount of pleuritic effusion. Continue treat- 
ment, and give, besides, infusion of juniper Oij ; acetate 
of potassa 5ij. M. A wineglassful every three hours. 

4zt7i, No changes to note. R. 01. jecoris aselli ^xij. 
S. A dessertspoonful thrice daily. B. Creasote nvviij ; 
aquae gij. M. S. A teaspoonful with each dose of the 
oil. A small quantity of solid animal food for breakfast 
and dinner. 

Qth. Strength much improved; complains of slight 
gastrodynia and some pyrosis. Has considerable cough, 
w^hich is deeper and more developed than heretofore. 
During the past twenty-four hours he has expectorated 
about a teacupful of semitransparent highly tenacious 
mucus, deeply stained with the coloring matter of blood. 
It adheres to the cup when turned upside down, floats 
on w^ater, and exhibits, under the microscope, an abund- 
ance of blood, but no trace of pus globules. The blood 
is nowhere found in separate dots or streaks, but is so 
intimately united with the mucus as to form a perfectly 



84 ILLUSTRATIVE CASES. 

homogeneous mass. Give him more nutritive food, and 
a little ale at dinner. Continue the strychnia. 

^tli. The sputa yesterday were unchanged in character, 
but more abundant ; to-day they are less copious, and 
contain one or two plugs of concrete albuminoid mucus. 
Yocal fremitus nearly alike over the posterior face of 
both lungs. 

l{)th. Sputa less abundant and more diffluent. He is 
sitting up to-day for the first time. 

12th. Sat up four hours yesterday. Cough shorter 
and more suppressed; product less abundant, hardly 
stained with blood, and floats in the spit-cup on a small 
quantity of serum. Continue treatment. 

16^^. Less cough at this stage of the case, and no ex- 
pectoration. From the middle of the scapula to the base 
of the left lung the dulness on percussion is absolute ; no 
trace of respiratory murmur, and palpation detects no 
vocal vibration, showing that as the pneumonic engorge- 
ment passed away the lung was compressed, and its place 
occupied by pleuritic efiusion. 

21^^. He rode out to-day for the first time. After 
moderate exercise, pulse one hundred and two, respiration 
twenty. The pleuritic eff'usion is manifestly greater in 
quantity. Take no medicine, live on nutritive diet, and 
exercise moderately in the open air. 

July 20. He has spent the past three weeks in the 
country, where he has walked about half a mile each 
day. Came to town, because, within the past five days, 
he has experienced a great increase of cough. This 
cough is clearly owing to a return of air to irritable 
bronchial surfaces, from which it has been so long ex- 
cluded. A loud redux friction sound can be heard over 
the axillary region. It would seem that one-third of the 
effused fluid has passed off, and there is every probability 
that the whole of it will disappear in a short time. 



ILLUSTRATIVE CASES. 85 

August 12. No farther diminution of the pleuritic 
effusion. He has very little cough, has gained some 
flesh and strength, and his spirit seems much better. 

September 10. During a severe paroxysm of cough, he 
expectorated about half a gill of pus, with a small quan- 
tity of blood. Take a moderate potation of wine, brandy, 
or porter, at dinner, and a tea composed of cortex casca- 
rilla 5ij ; life everlasting (gnaphalium polycephalum) ^ij ; 
boiling water Oj. A wineglassful before each meal, taken 
cold. 

October 13. He has been passing his time in a fine 
open region of country, twenty miles north-west of Bal- 
timore, and about one thousand feet above tide-water. 
He at first occupied a lower apartment, which was 
somewhat damp. The result was a renewal of pain in 
the left side, with manifest deterioration of his general 
health. He then moved into a dry attic room, having 
a sunny exposure, since which time he has been doing 
better, and is now able to take much more exercise. 
He has cavernous plashing, respiration and resonance 
just below the middle third of the clavicle on the left 
side, and raises each day some flakes of mucus, and a 
quantity of nummulated sputa. Continue treatment. 

Early in November, this gentleman went to Aiken, 
South Carolina; this residence was advised not with 
any hope of cure, but as a palliative expedient, and in, 
order that he might still exercise in the open air without 
contracting intercurrent pneumonia and catarrh, which 
he could hardly hope to avoid at home. The last 
accounts of him are to the 6th of the present month, 
March, when he was able to walk three miles daily 
without difficulty. 

Kemarks. — It has been seen that the first day this 
case came under notice, careful inspection of the chest 
detected no morbid sign, except a slight sibilant ron- 



86 ILLUSTRATIVE CASES. 

chus, and that for the first ten days there were no symp- 
toms indicating the existence of any other affection than 
a catarrh, which seemed to be very mild. On the 18th, 
after some exposure, the disease returned, accompanied 
with fever and sweating, but still without a sign of any 
affection besides bronchitis. The subsequent acute mor- 
bid lesions, commencing with the endocarditis on the 
20th April, and ending with the pleuritis on the 7th 
May, seem to stand in the relation of dependence upon 
the pre-existing idiopathic bronchitis, unless, indeed, 
this last-named primary lesion be regarded as symp- 
tomatic also of the foregone state of the fluids. From 
the 5th to the 18th, the urine was charged with the 
urates of soda, lime, and ammonia ; but so soon as the 
fever and sweating set in, these salts were replaced by 
crystals of uric acid. 

The endocarditis, recognized for the first time on the 
20th, indicated very clearly the existence of rheuma- 
tism, and the transfer of the murmur from the first to 
the second sound of the heart, noted on the 25th, shows 
evidently the metastatic character of the morbid ele- 
ment. It is manifest, also, that the endocarditis, when 
first observed, did not exist as an idiopathic lesion, but 
that it was symptomatic of the pre-existing fibrous 
bronchitis. No signs, general or local, of pneumonia, 
were noticed until the 25th day of the attack, and the 
seventh from the date of the relapse, when the occur- 
rence of the pulmonary engorgement was announced by 
the following contemporaneous signs : increased accelera- 
tion of pulse and respiration, fine dry rale, rusty sputa, 
and a brown tongue. It is hardly likely, therefore, that 
a latent central pneumonia had existed prior to this 
time; it is far more reasonable to suppose that it 
depended on an extension directly by contiguity, or con- 



ILLUSTRATIVE CASES. 87 

tinuity of the rheumatic inflammation from the fibrous 
tissues of the bronchi to the pulmonary parenchyma. 

The profuse sweating, which began with the fever on 
the 18th, and continued throughout the attack, and the 
great sensibility to cold which the patient experienced, 
owing to evaporation from the surface, are particularly 
worthy of note, as signs strikingly characteristic of acute 
rheumatic bronchitis. Prior to the 18th, the inflamma- 
tion seemed to be subacute in character, and the urine 
was charged with the urates of soda and lime ; but so 
soon as the fever and sweating set in, and as long as 
they continued, this salt was replaced by uric acid. 

Until the pneumonia set in, there had been no great 
degree of prostration, but, after the engorgement took 
place, the asthenic condition was very marked, and was 
most probably induced by the morbid accumulation of 
blood in the capillary vessels of the pulmonary paren- 
chyma. The direct shock inflicted on the nervous sys- 
tem by pneumonic engorgement seems not to be suf- 
ficiently appreciated ; it is as great in many cases as if 
a bullet had passed through or lodged in the lungs. 

The excessive buff on the blood, w^hich was not only 
greater, but more dense and resistant on the 30th than 
on the 25th day of the attack, is alwa^^s found in the 
acute form of rheumatic pneumonia ; it never occurs to 
the same degree in ordinary engorgement, and rarely in 
any other affections, except articular rheumatism, and 
some forms of serous inflammation. 

The strangury, which happened on the 26th April, and 
the nephralgia on the 7th May, were doubtless owing 
to the irritation produced at the neck of the bladder, in 
the first case, and afterwards in the kidney, by the pas- 
sage of uric acid. These accidents go to show still 
farther the large share of morbid action exerted by the 
rheumatic element throughout the whole course of this 



88 ILLUSTRATIVE CASES. 

prolonged attack, strangury and nephralgia being no 
uncommon occurrences on the subsidence of rheumatic 
inflammation. It may be here remarked that, in cases 
of nephralgia, depending on the irritating presence of 
uric acid and its compounds, with soda and lime, I have 
seen twenty grains of phosphate of ammonia afford com- 
plete relief in the space of five minutes ; and, where 
triple phosphates were found in excess, I have witnessed 
just as immediate subsidence of pain from the exhibition 
of lemon-juice or vinegar. 

The paroxysmal character of the cough, as well as 
the very great disproportion which it bore to the amount 
of sputa, is very striking. Even when the ear detected 
abundant moist sounds, the cough was often dry and 
unproductive, which was doubtless owing to the albu- 
minoid and viscid character of the secretions. 

Most observers have with truth come to the conclu- 
sion that rheumatism is the common producing cause of 
pericarditis ; but it is not insisted upon that the rheu- 
matic element is also a producing cause of pleurisy, 
because the pleura is not, like the pericardium, a fibro- 
serous tissue. Now with regard to the pleuritis, which 
commenced in this case on the 7th May, it may be re- 
marked that it came on when the fluids were highly 
charged with the urates, which had already produced 
nephralgia, congestion of the kidneys, and consequent 
suppression of urine, so that the farther elimination of 
these salts from the blood was entirely prevented ; and, 
besides, the cutaneous exudation had been arrested by 
chill, so that the nitrogenized elements could not be 
gotten rid of by the skin. Under these circumstances, 
then, the pleuritis set in, and, in the absence of all 
other causes adequate to the production of an inflam- 
matory process, it seems fair to attribute the pleurisy to 



ILLUSTRATIYE CASES. 89 

the irritating presence of uric acid, or its compounds 
with soda. 

If the arrangement of the pleura in its anatomical 
relations with the adjacent structures be considered for 
a moment, it will be found that it corresponds at some 
points with the serous membranes lining the tlieca ver- 
tebralis, pericardium, and other fibrous tissues proper; 
and, at others, with the gliding surfaces of the different 
articulations. Its close relation with the fibrous expan- 
sion of the diaphragm, and its fusion with fibro-cellular 
tissues, as it passes from the margin of every rib and 
covers the intercostal spaces, exhibits the first resem- 
blance; and its close adhesion to the costal and cartila- 
ginous surfaces, composing, in part, the walls of the 
chest, shows how nearly it approximates the arrange- 
ment of the internal articular coverings. To carry out 
the analogy, why may not the pleural cavities be re- 
garded as the capsules of large soft joints? These 
differences in the topographical arrangement of like 
tissues, may account for the frequency of idiopatbic 
pleuritis, and the rarity of peritoneal inflammation. Is 
there anything more unreasonable in a lithic acid than 
in a traumatic or tubercular pleuritis, except that the 
causes inducing the inflammatory lesions are more visi- 
ble, as well as tangible, in the one case than in the 
other ? It is believed that, as rheumatism comes to be 
better understood, it will be regarded more and more as 
an important link in the production and catenation of 
morbid actions. 

When it was found in this case that the pleuritic 
effusion did not yield to diuretics, blisters, iodine in- 
unction, and other treatment, it may be asked by some 
why the operation of paracentesis was not resorted to, in 
order to relieve the compressed lung by evacuating the 
fluid contained in the pleural cavity. In answer, it may 



90 ILLUSTRATIVE CASES. 

be stated that it was believed that the withdrawal of the 
fluid would of necessity fail to produce the relief desired, 
and that the consequences of the operation would most 
likely, under the circumstances, prove rapidly fatal, and 
for the following reasons. When a lung is simply carni- 
fied or compressed by a pleuritic effusion, its structure 
remains perfectly intact, and on the spontaneous or me- 
chanical evacuation of the fluid it becomes permeable to 
air, and resumes again its healthy functions. If slight 
pleuritic thickening and adhesions have taken place in 
the investing capsule of the lung, these will in most 
cases yield, so as not to interfere materially with the 
expansion and consequent return of the lung to the 
complete and healthy performance of its functions. But 
where, as sometimes happens, adhesive inflammation has 
taken place in the parenchyma of the compressed lung, 
and its difierent structures are matted and bound together 
by organized exudation matter, no healthy expansion can 
ever afterwards take place ; and if, under such circum- 
stances, the pleuritic effusion be withdrawn, the admission 
of air through the puncture, to take its place, or the 
formation of a vacuum, must be the necessary result. 
Now, if there is any condition under which a vacuum is 
particularly abhorrent to nature, it must be this. 

Where a lung laboring under simple pneumonia is 
compressed by pleuritic efi'usion, adhesive inflammation 
does not take place, because its tissues are kept apart by 
the engorgement in all the capillaries, so that the gluing 
together of its different structures cannot happen. Nei- 
ther is inflammatory adhesion likely to occur in ordinary 
catarrh, because of the repugnance mucous surfaces have 
to adhere, under the most favorable circumstances for 
adhesion. But in fibrous bronchitis there is a very 
opposite state of things; and where a lung laboring 
under this form of inflammation becomes compressed by 



ILLUSTRATIVE CASES. 91 

pleuritic eiFusion, its different structures are likely to be 
inseparably bound together by regularly organized adhe- 
sive lymph/ and for very obvious reasons. The blood, 
in the acute form of this disease, is always in the state 
most favorable to the pouring out of plastic lymph. The 
inflammation extends in many cases to the cellular plat- 
work of the lungs, and sometimes to the air-cells; but 
the pneumonia thus induced is generally limited, rarely 
goes beyond the first stage of engorgement, and conse- 
quently does not, as before explained, oppose a barrier 
to the complete pressure together and adhesion of the 
different pulmonary structures. 

^ In the case before us, with a full knowledge of the 
accidents likely to result from a compressed lung, the 
operation of paracentesis was abandoned, because it was 
believed that permanent adhesions of the pulmonary 
parenchyma had already taken place. 

To show the danger of puncturing the chest under 
the circumstances just narrated, the following case is 
given, w^here the operation of paracentesis was per- 
formed for the purpose of giving issue to a pleuritic 
effusion, which had supervened on a long-continued 
attack of fibrous bronchitis. 

Eliza Phene, unmarried, aged twenty, came into the 
lying-in ward of the Baltimore Almshouse, October, 
1843, pregnant with her second child, of which she was 
delivered in a few days. Some bronchitis of both lungs 
supervened two weeks afterwards, which became chronic, 
and lasted more or less through the following spring and 
summer. About the middle of March, it was found that 
she had contracted a pleuritic effusion in the left side, 
rendering about two-thirds of the parietes of that lung 

* See a paper by Dr. Corrigan, under the ill-chosen title of Cirrhosis 
of the Lung, Dublin Journal of Medical Science, vol. xvi. 



92 ILLUSTRATIVE CASES. 

dull on percussion. As well as could be ascertained, this 
had been present about two weeks. Under treatment, 
it was in some degree absorbed, but, in consequence of 
exposure, it increased, and rendered the whole left side, 
even to its summit, dull on percussion, with a total 
absence of respiration. The pulsation of the heart was 
also found to be on the right side. 

This state of things continued till September 11, 1844, 
when paracentesis thoracis was performed. At that 
time she suffered greatly from dyspnoea. Pulse one 
hundred and twenty-four, respiration twenty-four. Per- 
cussion over the left lung was dull everywhere, and 
no sound of respiration could be distinguished, except 
at its root, where we heard bronchial respiration and 
bronchophony. The impulse of the heart was on the 
right side, and there was more or less subcrepitant rale 
throughout the whole of the right lung, together with 
puerile respiration. The operation did not succeed, and 
the patient, after undergoing a variety of treatment, died 
on the night of October 6, suddenly. Immediately after 
the operation, the left side of the chest became sonorous 
on percussion, but there was no sign of respiratory mur- 
mur. The failure was owing to the fact, as we found 
afterwards, of the lung not expanding as the fluid was 
withdrawn. 

Autopsy eighteen hours after death. — The only abnor- 
mal change that had occurred was in the lungs and 
pleura. The place where the puncture had been made 
in the chest had reopened, and was giving vent to a 
yellow sero-purulent fluid of a very disagreeable odor. 

The heart was found somewhat pressed over to the 
right side; it had probably been more so, but the eva- 
cuation of the fluid had allowed it to resume nearly its 
natural place. The left lung, compressed to the size of 
a child's lung of ten years of age, was found lying close 



ILLUSTRATIVE CASES. 93 

to the spine, and the pleural cavity was filled with the 
fluid above mentioned. The pleura itself was covered 
with a pyogenic surface, and the membrane was much 
thickened. The lung did not at any place crepitate 
between the fingers and thumb, and seemed in a state 
of carnification, its structures being bound together by 
adhesive lymph. Throughout both lungs, a few small 
white masses about the size of a millet-seed were dis- 
coverable, which we supposed might be tubercles, or 
concrete albumen; but none w^ere discoverable on the 
pleura. 

This case, together with the previous considerations, 
is of much importance in deciding, in some instances, as 
to the propriety of an operation for empyema. I have 
operated for thoracic empyema in but two other cases, 
each of which turned out well. It is to be regretted 
that no notes were taken on either occasion. 

The first case occurred in a son of Dr. Waters, aged 
about eight years. The empyema in this case resulted 
from an attack of uncomplicated, acute, idiopathic pleu- 
risy. Most of the particulars connected with it having 
passed from my mind, I applied a short time since to 
the father, who obligingly furnished the following 
statement : — 

" Dear Sir : — 

"Your note of the loth inst., referring to my son's 
extraordinary illness and recovery, I proceed now, at 
the earliest opportunity afforded me, to answer, in the 
order of the questions enumerated. 

"1. It was some time, probably late in May, 1838, 
that the operation was performed. 

"' 2. My son was then about eight years old. 

"3. As he was taken ill in January or early in 
February preceding, according to my recollection, the 



94 ILLUSTRATIVE CASES. 

pleurisy had existed some three months when the ope- 
ration took place. 

''4. I apprehend that three pints or more of fluid were 
taken from him when the issue was stopped, and then 
it was still flowing as freely, it is probable, as when the 
puncture was made. 

" 5. The issue continued, and freely, for a week or 
more, whenever the orifice was opened ; nor did it 
cease to give matter — I judge for three weeks at least — 
until, supposing that it was wellnigh exhausted, we 
suffered it to close. In consequence, the fluid formed 
again, when a second puncture became necessary, which 
was followed by another copious flow of matter, though 
not so abundant as the first. This time we were care- 
ful to keep the orifice open till the appearance of pus 
entirely ceased, which I presume was as late as the last 
of August, or 16th September following. 

" The second operation was performed some six weeks 
after the first. 

'^ 6. My son showed no sign of convalescence whatever 
until the issue seemed completely exhausted, and, in- 
deed, not till some time after that; I might say, as 
strongly probable, not till late in September, or early in 
October. When convalescence became decided, the 
return of health was rapid, though he did not so rapidly 
regain his strength and the use of himself. This was 
owing to the position in which he was suffered to lie in 
bed during the period of his extreme illness. As his 
life was despaired of on all hands, he was permitted to 
lie, for weeks, with his legs drawn up to nearly a right 
angle, in consequence of which, and of his perfect ema- 
ciation and helplessness, the muscles behind the knee 
became shortened and completely rigid. His extremi- 
ties had accordingly to be rubbed, oiled, and pulled vio- 
lently, for weeks, before he could even stand, unless by 



ILLUSTRATIVE CASES. 95 

supporting himself; and much longer it was, probably 
not earlier than January following, before he could walk 
across the room without personal aid, or some mecha- 
nical assistance, as chairs or tables arranged for the 
purpose. 

"At what period his health was fully re-established, I 
am not prepared to say; that is, my memory is not 
sufficiently retentive to state with precision and certain- 
ty. During the process of recovery, however, he com- 
plained of nothing, except after he began to crawl about 
the floor, like a child in its first efforts at the same 
exercise or movement, he would occasionally cringe a 
little, and, to use his own words at the time, said to us, 
that something 'pinclied him about the region where the 
puncture was made. He has had no acute disease since, 
and, for years, his health and spirits have been as good 
and uniform as any other person's of my acquaintance ; 
I mean, of course, as respects personal comfort and 
enjoyment, inclusive of freedom from positive malady. 

" The attack, at the onset, was exceedingly rough and 
violent, and, unfortunately for us, our family physician 
was from home when sent for, and my son ought to have 
been bled thirty hours before his physician saw him at 
all. The consequence was, the disease took an unyield- 
ing hold, and in its progress assumed extraordinary, 
and, I apprehend, anomalous forms, so that gentlemen 
of large experience and known ability in the profession, 
concluded, at one period, that the lung was hepatized 
and much enlarged, as seemed indicated by the appear- 
ance of the chest, and the fact that the heart pulsated 
on the right of the sternum. It was some weeks, may- 
be three or four, more probably six, after this, that you 
saw the case for the first time, when that entire emacia- 
tion had taken place which you so well remember. 

"The subject of this case is now a strong and active 



96 ILLUSTRATIVE CASES. 

gentleman, in his twenty-third year. He has slight 
curvature of the spine, the convexity of which is towards 
the right scapula, and from the centre of the sternum 
to the spinous process of the middle dorsal vertebra he 
measures two inches more on the right than on the left 
side, but the deformity is not a source of even the 
slightest inconvenience." 

In the foregoing case, the emaciation was so very 
great that the inequalities of the alveolar processes were 
distinctly visible through the upper lip, the mouth being 
closed. The matter also jutted out between the ribs, 
rendering each intercostal space very prominent j but 
without any disposition to point at any particular place. 
The division of the tissues, to give exit to the matter, 
was a mere nick or transverse cut, rather than a punc- 
ture ; all of them together — skin, muscle, and pleura — 
were hardly thicker than ordinary drawing-paper. 

The subject of the other operation was the captain of 
a bay boat. The quantity of greenish-yellow matter 
removed was somewhere over three pints. No precau- 
tion was taken, either by a flap opening or otherwise, to 
exclude air; on the contrary, the puncture was made 
with an ordinary thumb lancet, low down on the left 
side. And then, to excite inflammation, and thereby 
alter the condition of the pyogenic surface, some three 
or four very small gum-elastic bougies, twelve inches 
long, were introduced to w^ithin half an inch of their 
heads, which were firmly tied together by a string, and 
this was made fast to the side by adhesive straps. They 
were suffered to remain in the pleural cavity for about 
thirty-four hours. The man suffered little or none from 
the effects of the operation, and at the end of two weeks 
returned home. A month after, having come back to 
the city, suffering, as at first, from dyspnoea, it was ascer- 
tained that the puncture had closed perfectly, and that 



ILLUSTRATIVE CASES. • 97 

the side was again filled with fluid. A second puncture 
was made, and after the matter, amounting to about a 
quart, had discharged itself, a weak solution of iodine 
was thrown into the pleural cavity. Hectic and rapid 
emaciation supervened in a few days ; and at last the 
man suffered dreadfully from diarrhoea, and also from 
aphthous ulceration about the mouth and pharynx, with 
loss of voice. A silver canula, bent at right angles, 
was placed in the opening, the outer half, pointing 
downwards, rested against the skin of the thorax. 
Finally, it was decided, if he remained any longer ex- 
posed to confined air, rendered highly putrid by the free 
discharge of a very fetid pus, that death must soon 
ensue. Accordingly he was carried down stairs, placed 
recumbent in a furniture wagon, and taken on board 
his boat, about to sail for home. Some three months 
having elapsed, he returned again to town, in the enjoy- 
ment of perfect health. He still continued to wear the 
canula, from which a small quantity of sero-pus was 
each day discharged; and whenever this tube became 
clogged, he was in the habit of removing it, and often 
pulled from the opening shreds, or rather ropes, of 
coagulated lymph. About twelve months more having 
elapsed, I again saw this man, when the puncture 
had closed, and he seemed to be in the most robust 
health. 

The operation for thoracic empyema, originally limited 
in its meaning to the surgical evacuation of pus from 
the pleural cavities, is now understood conventionally 
to signify, the giving issue to serum or any other form 
of fluid contained in those cavities. 

Whenever paracentesis has been performed for the 
purpose of evacuating true pus, which had formed as 
a result of simple idiopathic pleurisy, a very rare termi- 
nation of this disease, the propriety of the operation has 
7 



98 • ILLUSTRATIVE CASES. 

never been doubted. Even in tubercular pleuritis, the 
giving issue 'to pus is advocated by the best authorities 
as a palliative, and may often be resorted to with benefit. 
In 1842, I witnessed the case of a mulatto boy, aged 
eighteen, who, presenting the strongly-marked facies of 
the strumous diathesis, labored under tubercular deposit, 
with softening at the summit of both lungs. Having 
suffered for months from hemorrhage, hectic, night- 
sweats, and extreme emaciation, a pleurisy set in on 
the left side, and, after a short time, the entire pleural 
cavity was filled with pus. The dulness was absolute 
over every region of the left side of the chest, except 
over a triangular space between the dorsal summit of 
the lung and the spinal column, where a crepitant 
ronclius was heard. At this stage of the case, he suf- 
fered, as a consequence of interrupted circulation, with 
ascites and excessive oedema of both lower extremities. 
Paracentesis thoracis was meditated, and finally aban- 
doned as being, under the circumstances, an utterly 
useless expedient, even as a palliative ; but nature pro- 
vided for him more wisely than his physician. The 
pus found its way, by a spontaneous opening, either into 
the stomach or oesophagus ; he vomited up at intervals 
the whole purulent contents of the pleural sac, and the 
lung, apparently not more damaged than before, resumed 
its original position. For weeks he continued to vomit 
a greater or less quantity of extremely fetid pus. 

During the whole course of his disease, he took nothing 
except nutritive diet and a strong decoction of "life- 
everlasting," which was advised by his mother, a worthy 
and intelligent negress. 

Finally, I saw this boy some twelve months afterwards, 
when he had regained his usual flesh and strength, and 
was employed as a house-servant. Careful inspection of 
his chest could detect no softening, but there was com- 



ILLUSTRATIVE CASES. 99 

parative dulness on percussion over the whole left side, 
besides prolonged expiration, with increased fremitus and 
vocal resonance at the summit of the left lung. lie in- 
formed me that he had continued to nse daily, and was 
still taking, the ^'life everlasting." I may add, that of 
late years I have used this. plant very largely in the treat- 
ment of phthisis, with most excellent results. A pint 
of the tea daily, made as strong as possible from the 
stems, leaves, and flowers of the dried plant, should be 
taken cold, and continued for months. This plant (gna- 
phalium polycephalum) grows in great abundance on 
waste soils in the temperate regions of both Europe and 
America. I had no other authority for its use, in the 
beginning, except the knowledge that it was a popular 
remedy amongst our negro population in all cases of 
chronic cough. 

It may not seem out of place here to raise a feeble 
voice against the operation of paracentesis, as recom- 
mended and practised by M. Trousseau, of Paris, and 
lately advocated, in a very plausible article, by an able 
writer, in a late number of the American Journal of the 
Medical Sciences. 

While for a series of years physician to the Baltimore 
Almshouse, an institution containing a large number of 
inmates, I was constantly on the lookout for some case 
in which the operation of paracentesis might be per- 
formed with benefit to the patient. In every instance 
the effusions resulting from acute idiopathic pleurisy 
were absorbed, except in the case of poor Phene, already 
reported, where the puncture of the side, for the reasons 
already assigned, had far better have been let alone. 

Dr. Stokes reports twenty cases of pleuritic effusion 
cured by iodine inunction ; but he might have said, with 
truth, as every one at all familiar with the subject must 
know, that at least nineteen of these cases would have 



100 ILLUSTRATIVE CASES. 

gotten well had they been left to the unassisted powers 
of nature. 

Every observer must have noticed that pleuritic effu- 
sions, which resist for a season all known modes of medi- 
cation, will often yield in a very short time to nutritive 
diet and exercise. It is also known that a very large 
majority of these effusions get perfectly well, where 
neither the individuals laboring under them nor their 
medical attendants are aware that the fluid in question 
exists. 

Now, this work, which nature performs so well, so 
silently, and so thoroughly, two very eminent gentlemen 
have proposed to accomplish by art alone, more expe- 
ditiously, it is true, but, in most cases, it is believed, 
with far greater subsequent risks to the patients. 

M. Trousseau performs the operation of paracentesis 
thoracis for the purpose of giving issue to very recent 
pleuritic effusions occurring in both sexes before the age 
of puberty. And Dr. Bowditch, of Boston, says :^ " I 
believe that this operation will be used with advantage 
in acute disease, and may likewise shorten its course." 
Now, these gentlemen should first have shown that idio- 
pathic pleurisy is a dangerous disease ; next, that death 
often happens from asphyxia resulting from recent serous 
effusion ; and thirdly, that paracentesis gives issue to the 
fluid with more security to the life and future health of 
the patient than where nature herself accomplishes the 
same result by absorption. All of which propositions 
are denied. Besides, these gentlemen, while advocating 
paracentesis as a more common procedure in recent effu- 
sions, have forgotten to state the most valid objections 
to the evacuation of the fluid. The effusion, by arrest- 
ing the expansion of the lung, secures to the surfaces 

^ Amer. Journ. Med. Sci. for April, 1852, p. 345. 



ILLUSTRATIVE CASES. 101 

laboring under inflammation the most perfect rest; it 
not only prevents the chafing together of the walls of 
the pleura costalis and the capsule of the lung, but, at 
the same time, furnishes the best dressing for the in- 
flamed membrane; the fluid separates the pleura of the 
lung from that of the ribs, and thereby prevents the 
adhesion and consequent structural alterations that 
would otherwise ensue; and, when no longer required 
for these objects, it passes off by absorption. Why, 
therefore, by artificial means interfere with a wise con- 
servative provision of nature, set up for the express 
purpose of warding off the only accident likely to result 
from pleuritis ? These considerations lead to the con- 
clusion that paracentesis should never be resorted to 
where the pleural cavities contain only serum, unless, 
what is extremely rare, the unusual accumulation threat- 
ens death from suffocation. As far as my limited ob- 
servation extends, serous effusion, threatening asphyxia, 
is far more apt to occur in traumatic than in any other 
form of pleurisy. I have seen two post-mortem exami- 
nations which, together with the previous history of the 
cases, showed conclusively that the individuals must 
have died asphyxiated by pleuritic effusion. In both 
instances, the pleurisy resulted from fractured ribs. 

A very notable example in which death took place 
from serous effusion, is the case of Sir Kobert Peel, whose 
valuable life would most likely have been saved by the 
timely introduction of a trocar. No one at all convers- 
ant with such matters can read the very minute account 
of the last hours and death of the great statesman with- 
out seeing that he died from asphyxia. The mode of 
death, and the nature of the injuries, which were not 
discovered until too late, go to show, as conclusively as 
possible, that he died from suffocation induced by ex- 
cessive effusion into one or both of the pleural cavities. 



102 ILLUSTRATIVE CASES. 

Had Sir Robert been a drayman, carried into St. Bar- 
tholomew's Hospital with similar injuries, the same 
attendants would no doubt have detected not only the 
fractured ribs, but also the pleuritic effusion, and relief 
would have come even at the ninth hour. The miserable 
excuse for not detecting these accidents until after death 
is, that Sir Robert suffered such extreme pain when the 
least examination was attempted. "Why could not his 
injuries be detected as easily as those of any other 
individual? Chloroform was known and in use at the 
time, and why was not this resorted to, if necessary, to 
produce the requisite degree of anaesthesia ? 

It may be thought by some that the case which fur- 
nished the subject of the foregoing remarks, was from 
the first one of acute phthisis, but a rigid analysis of all 
the phenomena will convince them that such was not 
the case, and that the tuberculous state of the left lung 
was not a primary, but a secondary lesion, growing out 
of the deterioration of the general health which induced, 
and the compressed lung which favored, the deposit of 
tuberculous matter. Acute phthisis would have run its 
course more rapidly, and the deposit would most likely 
have existed in both lungs ; whereas, on the contrary, 
there was no evidence of softening on the left side until 
the 10th September, at which time the right lung was 
still intact. 



ILLUSTRATIVE CASES. 103 



CASE YII. 

ACUTE ENDOCARDITIS AND FIBROUS BRONCHITIS ENGRAFTED 
ON A CASE OF OLD VALVULAR ALTERATION AND HYPER- 
TROPHY OF HEART. 

January 4, 1852. J. F., a currier, of temperate ha- 
bits, aged thirty-nine, under the care of his family 
physician. Dr. Stevenson, has been confined to bed for 
three weeks with cough and pain in the left side of the 
chest; the attack having been brought on by going 
repeatedly from a heated room into a cold and damp 
cellar, where he was often compelled to remain for some 
time for the purpose of w^eighing leather. His health 
has always been good, with the exception of an attack 
of acute articular rheumatism he suffered in the winter 
of 1843, since which time he has often been greatly 
troubled with palpitation of the heart and short breath. 

He is propped up in bed, and labors under some dys- 
pnoea. His countenance is anxious, and has the ex- 
pression of a man beset by fears. He says that he has 
a feeling of constant alarm, and that he is all the while 
teazed wdtli an undefined apprehension of impending 
danger. He complains of pain in the left side, ex- 
tending from the nipple to the base of the subaxillary 
region, and has suffered with several attacks of severe 
angina. He is annoyed, also, with fleeting pains in the 
left arm, and constant aching at the insertion of the 
deltoid muscle. The urine voided last night is about 
normal in quantity, but very turbid. Has constant 
cough, and expectorates nothing but a little mucus, 
mingled with frothy serum. Tongue clean, skin dry, 
bowels regular. Pulse ninety-eight, open, soft, but 
somewhat irregular. Palpation detects abnormal im- 



104 ILLUSTRATIVE CASES. 

pulse of heart, which is felt as high as the second rib. 
Auscultation recognizes a harsh and loud murmur, syn- 
chronous with the second sound of the heart. Moist 
crepitant rale of oedema at the base of both lungs ; some 
sibilant rale over every part of the chest ; and a sub- 
crepitant rale over a disk the size of a dollar at the 
base of the subclavicular region on the right side. Diag- 
nosis: rheumatic bronchitis, and endocarditis engrafted 
on old valvular alteration and hypertrophy of heart. 

Prognosis, — Will resume the health he had antecedent 
to this attack. Treatment. R. Moschi gr. xvj ; assa- 
foetid. 5ss; sulph. ether dilut. ^ij. M. S. A teaspoonful 
every six hours, and ofteuQr if the angina returns. Also, 
R. Phosph. ammoniae ^ss; aquae gvj. M. S. A table- 
spoonful every eight hours. 

bth. He suffers less dyspnoea, and is able to rest in 
a more recumbent posture. Signs unchanged. A spe- 
cimen of urine, voided yesterday, is found to contain an 
abundance of urates of soda and lime, and an excess 
of earthy phosphates. Continue treatment, and give, 
besides, the acid of one lemon in water, and a table- 
spoonful of vinegar thrice daily. 

^iJi. He has acute rheumatism, which began yester- 
day in the articulations of the middle and ring fingers, 
with the corresponding metacarpal bones of the right 
hand; both of these joints being red, tumid, and ex- 
tremely tender. 

lltli. He was seized last night, and still suffers with 
acute rheumatic inflammation in the right knee-joint. 
He has less pain in the chest, no dyspnoea, very little 
cough, is able to rest in a recumbent posture with com- 
fort, and the subcrepitant rale, which has been con- 
stantly present at each observation until to-day, over a 
circumscribed spot on the anterior face of the right 
lung, is no longer heard. Continue treatment. 



ILLUSTRATIVE CASES. 105 

lotJi. At intervals, for the last two days, he has been 
sweating freely. The pain left the knee-joint last even- 
ing, and in the night the cough returned with increased 
dyspnoea. The subcrepitant rale is again present at 
the point before described on the anterior face of the 
right lung. The cough has disturbed his rest, and he 
complains of feeling very weak. Continue previous 
treatment, and R. Guaiac. contus. aj ; Holland gin^S^ 0>. 
M. S. A tablespoonful every four hours. B. Pulv. ipe- 
cacuanhse comp. gr. xij at night. 

17 tJi. He has been seized again with severe pain in 
the right knee-joint. The cough and dyspnoea are 
greatly mitigated, and the subcrepitant rale has again 
disappeared. Continue treatment. 

21st. General health improved. The white tissues 
about the right knee-joint are slightly thickened, and 
the joint is quite tumid, but free from pain. Some 
cough, with slight mucous sputa. Subcrepitant rale 
over the circumscribed spot on the face of the right 
lung. Faint sibilant rale, and less dyspnoea. 

Remarks. — Although the details of this case are in- 
complete, the above facts are given as they were noted 
at the time, on account of the remarkable metastasis of 
the rheumatic element. The writer did not see this case 
subsequently to the 24th of January, but Dr. Steven- 
son assures him, that the transfer of disease took place 
to the knee-joint a third time, with marked mitigation 
of the cough and dyspnoea. The rheumatic element 
being at last exhausted, he recovered slowly, and on the 
20th of February returned to his accustomed occupa- 
tion, in as good health as he had enjoyed antecedent to 
this attack. 



106 ILLUSTRATIVE CASES. 



CASE VIII. 

SYMPTOMATIC FIBROUS BRONCHITIS OCCURRING IN AN OLD 
CASE OF TUBERCULAR PHTHISIS. 

H. C. J.J a valetudinarian, aged fifty, of delicate 
figure and extremely feeble constitution, has been labor- 
ing for the last ten years under tubercular phthisis, 
which had been preceded for a long time by dyspepsia 
with its multiform symptoms. For the past two years, 
under the influence of cod-liver oil, acclimation, vege- 
table tonics, generous living, and great attention to 
health, his condition has been better, notwithstand- 
ing the existence of an anfractuous cavity at the top of 
the right lung, from which he lias voided variable quan- ,/ 
titles of nummulated sputa. He has also some efiapjema- ' /^ 
on both sides, particularly the right. He made a 
visit to New York in November last. Two days before 
his return to Baltimore, having undergone unusual ex- 
posure to cold, besides being greatly fatigued, he went 
to his chamber, feeling badly, and was greatly annoyed 
at night by feverishness, loss of rest, and aching in every 
limb. The following morning, having a chilly sensa- 
tion, he took a hot-bath, which he says did not make 
him feel warm, but had the effect of removing the 
general muscular soreness, and producing in the place 
of it a pain in the left knee-joint. The following day 
(December 6) he suffered from pain, but in spite of this 
inconvenience he resolved to come to Baltimore, which 
he did in twelve hours; experiencing all the while great 
increase of pain from the vibratory inotion of the rail- 
road cars, and having to be carried, at the different 
stopping-places, in the arms of his friends. He placed 
himself under my care on the morning of the 7th, when 



ILLUSTRATIVE CASES. 107 

he labored under considerable fever and great prostra- 
tion. The left knee-joint hot, tumid, and extremely 
painful on the slightest pressure, presents -a flush of red- 
ness on the inside, particularly over the space where 
the outer edge of the semilunar cartilage is attached to 
the capsule. Tongue covered with a white coat; much 
thirst; and total loss of appetite. His spittoon contains 
about half a gill of nummulated sputa, and some mucus. 
The urine, small in quantity, scalding when voided, and 
of a deep red tint, has deposited a pink precipitate on 
the bottom of the vessel. R. Unguent, hydrarg. mit.; 
emp. galbani comp. ; ung. stramonii, aa oj ; gum cam- 
phor 5iij. M. S. Spread on a rag and apply to the 
knee. Also a neutral solution of phosphate of ammonia, 
in doses of fifteen grains every six hours, and an ano- 
dyne at bedtime. 

Sth. The urine voided yesterday contains a consider- 
able excess of uric acid, and some urate of soda. 

The above treatment was continued until the 27th, 
when the knee-joint, together with the general condition 
of the patient, had so far improved, that all medication 
was laid aside, except the anodyne at bedtime. 

January/ 7. The weather is so cold that he finds it 
impossible to preserve a proper temperature in his room, 
and still more the warmth of his extremities. Knee- 
joint more painful, with augmentation of thirst and 
fever. Resume the local and general remedies. 

12t7i. The urine, which has been very red for some 
days past, is now of a pale straw color. The knee-joint 
is free from pain, but more puffed and swollen than it 
has been at any previous date. 

lotJi. He is annoyed with a harassing and almost 
constant cough, which is unproductive, except in the 
morning, when he voids the usual amount of nummu- 
lated sputa. 



108 ILLUSTRATIVE CASES. 

IQtJi. The cough continues unabated in violence; 
some sibilant rale on both sides of the chest; slight sub- 
crepitant rale at the base of the left lung ; cavernous signs 
unaltered. The cup contains about the usual amount 
of muco-purulent secretion, mingled with about a gill of 
albuminous serum. Continue previous treatment; take, 
besides, one drop of medicinal prussic acid every three 
hours, and double the anodyne at night. 

There was slight return of pain in the knee on the 
19th; and, on the morning of the 20th, he raised the 
usual quantity of nummulated sputa, but no serum, and 
the paroxysmal cough has almost entirely ceased. 

No farther accident occurring, he continues steadily 
to improve, and is now, on the 20th day of March, much 
weaker, of course, but in other respects very much in 
the condition he was antecedent to the attack of rheu- 
matism. 

It would seem, in this case, that the sudden accessions 
of cough were due to a metastasis of rheumatism to the 
bronchial tubes, and again that the cessation of the 
paroxysms was owing entirely to a return of the morbid 
element to the knee-joint. 



CASE IX. 

IDIOPATHIC FIBROUS BRONCHITIS, AND SUPERVENING HYPER- 
EMIA INVOLVING A PART OF THE LEFT AND ALMOST THE 
ENTIRE RIGHT LUNG. 

I saw this case of pneumonia with Dr. E. Thomas, to 
whom I am indebted for the following report : — 

" G. K., a carpenter, of dissipated habits, some three 
or four days before being taken sick, had been exposed 
on a cold evenin.2: to rain for several hours. He com- 



ILLUSTRATIVE CASES. 109 

plained, when I first visited him, of severe pains in his 
breast, back, and shoulders, and of aching in all his 
limbs. His pulse was somewhat depressed, and as he 
labored under slight temulentia, I concluded that he 
had been drinking some days before, and that he had 
only to recover from the effects of a debauch. Ordered 
a stimulating liniment, and an anodyne to be given at 
bedtime. Two days having elapsed, I was again sent 
for, with a notice that he was very ill. Visited him, 
and still thought that he was not very sick. His family 
stated that he had been very uneasy the night previous, 
slightly delirious, and complaining of pains in the chest, 
with a hard, dry, hacking cough. Examined his lungs 
very carefully, but could find not the slightest trace of 
disease. I was convinced, from circumstances that had 
come to my knowledge, that his sickness was mere pre- 
tence; but, to satisfy him, ordered a mild purgative. 
Did not visit him again for three days, when his family 
sent me a statement that he was very bad. Found him 
with a hot, dry skin, flushed face, furred tongue, irri- 
table pulse, and still complaining of severe pain in the 
chest. His cough was hard and hacking, but he raised 
nothing. Examined his chest, and was surprised to 
find what I believed to be signs of pneumonia at the 
top of the right lung. On account of his habits, did not 
like to bleed him. Gave antimony ; called to see him 
on the evening of the same day, and found him 
worse. Took about six ounces of blood from the arm, 
appUed a small blister to the chest, and gave him, be- 
sides the antimony, calomel and Dover's powder. The 
next morning he was no better ; his pulse was frequent 
and feeble -, his skin evacuating freely, copiously ; his 
urine high-colored and scanty ; his cough still continuing, 
but accompanied with very little rust-colored expectora- 
tion. The physical signs of pneumonia were now posi- 



110 ILLUSTRATIVE CASES. 

tive ; he had fine, dry, crepitous rattle over a small space 
at the base of the left lung, behind. On the right side 
the same fine, dry crepitation was found, from the 
clavicle to the fourth rib, under the arm as high as my 
ear could reach, and over the scapula. I again bled 
him moderately from the arm, and prescribed a Dover's 
powder in addition to what he was already taking. In 
the evening, his condition was in no manner improved; 

considered him sinking, and called in Dr. ; we both 

looked upon his situation as almost hopeless ; he lay on 
his back, with his mouth open, features sunken, pupils 
dilated, excessive hebetude, tongue coated and very dry, 
his surface cool and damp, respiration rapid, pulse fre- 
quent, some cough, but no expectoration, and scanty 
urine, of a deep reddish cast. We continued the pre- 
vious treatment, omitting the antimony, and directed, 
besides, a small quantity of spirits, at intervals, in water. 
The next morning, if there was any change, his condi- 
tion seemed worse. Reduced the dose of calomel and 
Dover's powder, and gave phosphate of ammonia, in 
twenty-grain doses, every four hours. He seemed to 
sink gradually, until evening, when I did not believe 
that he would live an hour. The following day I found 
him still alive, and in a better state. His sweating was 
less profuse, his urine more abundant, and his surface 
warmer. From this time, under the influence of phos- 
phate of ammonia alone, his condition slowly, but very 
steadily improved; and if he does not owe his recovery 
to the alkaline treatment, my judgment is at fault." 

Remarks. — The points of interest in this case are, 
that the patient suffered at first with unmistakable 
signs of muscular rheumatism; and, at the same time, 
he labored ander distressing cough, without expectora- 
tion, or any other general or local sign of catarrh. Had 
a pneumonia existed in this case prior to the sixth day 



ILLUSTRATIVE CASES. Ill 

of the attack, Dr. Thomas, who has much skill as an 
auscultator, could not have failed to detect it. The 
negative auscultatory signs prior to that period, together 
with the general symptoms, go to show that this was no 
local central pneumonia, which had extended little by 
little to the periphery of the lung; but that it was at 
first a fibrous bronchitis, which gradually traversed by 
continuity to the terminal tubes, and, finally, by con- 
tiguity to the air-cells, developing active hypersemia, 
and causing the pouring out of plastic lymph, and all 
the other phenomena of pneumonia. 

The appearances furnished by the urine showed very 
clearly that uric acid was the element at work, and the 
correctness of this opinion is confirmed by the decidedly 
beneficial and permanently useful effects of phosphate of 
ammonia. I visited this case with Dr. T., on the 14th 
of February, 1851, and on that day, the eighth from the 
date of seizure, the pneumonia was still in the first, 
verging towards the second stage of red engorgement. 



CASE X. 

FIBROUS BRONCHITIS AXD RHEUMATIC PNEUMONIA. 

S. L., born of healthy parents, and aged six years, has 
never been the subject of any attack incident to child- 
hood. About fifteen years since, his mother suffered for 
more than four months under severe articular rheuma- 
tism, but finally recovered, without mischief about the 
heart or other structural lesion. 

On the 6th of November, 1852, this little boy, while 
returning from school in Boston, fell into a puddle, and 
got the clothes covering his chest very wet. The follow- 
ing day he had cough, but no fever, and did not seem 



112 ILLUSTRATIVE CASES. 

sick. On the 8th, the cough being about the same, he 
left home under the care of his aunt, and, undergoing no 
particular exposure, came to Baltimore, where he arrived 
on the evening of the 9th. To-day (the 10th) he seemed 
drooping, and, the cough growing more distressing, I was 
asked to see him. He has some heat of skin and a pained 
expression of countenance, which wears a frown, and a 
deep, irregular, and diffused flush on both cheeks. The 
cough is not violent, but dry, and so very constant that 
he has hardly sufficient command of his breath to utter 
two consecutive words. No pain about the chest, or post- 
sternal soreness. Tongue white j anorexia; some thirst; 
bowels healthy. Pulse one hundred and twelve; respi- 
ration frequent, and not easily counted. Careful exami- 
nation of the chest, both by auscultation and the hand, 
can detect no single trace of anything wrong about the 
lungs, but a marked murmur is distinctly heard with the 
first sound of the heart. Palate and pharynx healthy. 
B. Magnesiae ustae 5j, at one dose. R. Pulv. ipecacuanhae 
gr. X ; water, six spoonfuls. S. A spoonful every three 
hours. A hot foot-bath, demulcent drinks, and some 
paregoric to lull the cough. 

Wth. Condition unchanged; flushing of the cheeks 
transient and irregular, often leaving the face quite pale. 
R. Tart, antim. et potass, gr. iij ; aquae ^i. M. S. From 
ten to fifty drops in water ; increase the dose until 
nausea is produced, and lessen the quantity if it excites 
vomiting. R. Pulv. ipecacuanhae comp. 9 j. In chart, x 
divid. S. One every three hours, as long as the cough is 
troublesome. 

12th, Has passed a restless night, and had, during the 
short intervals of sleep, a good deal of jerking and catch- 
ing in both the upper and lower extremities, but no 
subsultus or twitching. Much sweating; cough very 
annoying. No other sign about the chest except a very 



ILLUSTRATIVE CASES. 113 

frequent respiration. Pulse one hundred and ten. One 
small stool. Continue previous remedies, and give ten 
drops of wine of colchicum every six hours. 

loth. Condition and signs unchanged, except that a 
faint sibilant rale is heard at the summit of the right 
lung. Continue treatment. 

14zt7i. Flushing of the cheeks very variable, both as to 
degree and situation. Pulse one hundred and twenty- 
five, respiration forty. Cough less incessant, deeper, and 
more paroxysmal ; no expectoration ; vomited twice 
during the night, but the fluid voided contains no mucus ; 
two stools ; urine of a pale straw color, and deposits, on 
cooling, a white precipitate. Continue treatment, and 
give, in addition, the acid of one lemon daily. 

loth. Much sweating; cough less frequent; flushing 
of the cheeks deeper and more persistent. Pulse one 
hundred and thirty, respiration fifty-five. The fine dry 
rale of commencing pneumonia is heard from the clavicle 
as low as the third rib, and above the spine of the sca- 
pula on the right side. M-urmur with the first sound of 
the heart less marked. Venesection to four ounces, failing 
to get more because of the smallness of the superficial 
brachial veins. Continue previous remedies, increasing 
the dose of antimony. B. Submur. hydr., pulv. ipecac- 
uanhse, aa 9j. M. in chart, x divid. S. One powder every 
six hours, alternating its exhibition with the antimony. 

IQth. Lies constantly on the right side. Blood drawn 
yesterday slightly bufied; dulness on percussion; tubal 
respiration; increased vocal resonance and thrill on pal- 
pation for three inches below the clavicle on the right 
side, where some moist bubbles are also heard. Increased 
bronchial respiration and dulness on percussion over the 
supra-spinal fossa. Below these regions, both over the 
anterior and posterior surfaces of the right lung, the 
vesicular murmur is pure but feeble. On the left side, 
8 



114 ILLUSTRATIVE CASES. 

there is everywhere intensified puerile respiration. The 
stomach tolerates fifty-five drops of the antimonial solu- 
tion, while every powder has produced vomiting. Con- 
tinue treatment, reducing the quantity of each powder 
until it produces only nausea. 

VJth. Has had three stools, preceded by slight tormina. 
Stop the colchicum, and continue the other remedies. 

l^tJi. Has passed comparatively a quiet night. Tongue 
cleaning ; cough broken and loose ; murmur with the first 
sound of the heart no longer distinguishable ; resolvent 
rattle of convalescent pneumonia over the anterior and 
posterior face of the right lung at its top. Continue 
treatment. 

20^A. Countenance more cheerful, and face less flushed; 
respiration and pulse reduced in frequency; vocal thrill, 
tubal blowing, and dulness on percussion less marked ; 
bowels torpid. Continue remedies, and resume the col- 
chicum. 

2\st. Condition much improved; tongue clean and 
smooth. Pulse eighty-six, respiration twenty-seven. 
Some coarse crepitant ronchi below the clavicle on the 
right side, and the fine subcrepitant rale of capillary 
bronchitis over the base of the infra-axillary region, 
where, until this time, the lung has been perfectly free. 
With these exceptions, the signs are alike healthy on 
both sides. Continue treatment. 

22c?. Condition improved ; local signs unchanged. Stop 
all the previous remedies. E. Ext. actaBa rac. 5iij ; bi- 
carb, sodae gss; syr. prunus YirginianaB gvj. M. S. 
A dessert-spoonful every three or four hours, in water. 

2itli, This morning, the little fellow was seized with 
pain in the left shoulder and arm, so severe that it 
caused him to cry out, and since then his cough has 
ceased. 

26^/i. The pain in the arm is relieved, and he has 



ILLUSTRATIVE CASES. 115 

neither cough nor other unhealthy signs about the chest. 
He is therefore pronounced fairly convalescent, and 
recommended to be kept for a few days on mild diet. 



CASE XI. 

ACUTE IDIOPATHIC FIBROUS BRONCHITIS, WITH SYMPTOMATIC 
ENDOCARDITIS, OTITIS, SLIGHT GENERAL RHEUMATISM, AND 
FINALLY PNEUMONIA. 

N. T., a little girl born of healthy parents, aged four 
years, and possessing a remarkably vigorous constitu- 
tion; has never suffered any of the diseases peculiar to 
childhood. At two years of age she labored under a 
grave form of typhoid fever, followed by purpura haemor- 
rhagica, which latter accident had nearly proved fatal; 
but after a prolonged attack and a tedious convalescence, 
she recovered perfectly. 

On the 9th February, 1853, having been in a heated 
room for many days, and exposed at night to a cold 
draught from a flue communicating with the open air, 
she was attacked with slight chilliness, followed for 
several days by moderate fever, irregular and diffused 
flushing of the cheeks, much sweating, considerable 
prostration, and cough, without auscultatory signs. 
These symptoms remaining unchecked by the use of 
mild febrifuge means, she was seized on the 18th with 
violent otalgia on the left side ; so severe at times as to 
cause her to scream with pain. Three leeches were 
applied directly at the base of the tragus, and, after the 
loss of several ounces of blood, warm fomentations were 
kept over the ear, and full anodynes given without pro- 
curing sleep or affording any relief to the pain, which, 
however, gradually abated, and passed away entirely on 



116 ILLUSTRATIVE CASES. 

the third day. During the existence of the otalgia, the 
cough subsided altogether, but returned again as the 
earache ceased. On the 26th, she was again seized 
with excruciating pain in the right ear, when the leech- 
ing and other remedies previously used on the opposite 
side, were resorted to anew without relief; the pain 
augmenting for twenty-four hours, and apparently made 
worse by noise, finally subsided of itself on the 29th; 
after which time, there was a slight otorrhoea of a watery 
and ceruminous character. The cough having ceased 
as before, when the earache commenced, returned with 
renewed violence as the pain subsided. In the ear last 
affected, there was marked deafness for many days. 

30th. Profuse sweating; manifests great sensibility to 
cold ; pulse one hundred and forty-five ; respiration from 
sixteen to twenty. The cough generally short, constant, 
and worrying, but occasionally loud and paroxysmal; is 
uniformly dry and unproductive. Slight murmur with 
the heart's second sound. Respiration healthy, with 
the exception of slight rudeness on the right side. 

March 3. Complains much of pain in the legs, particu- 
larly about the right knee-joint; excessive sweating; 
less cough; increased roughness with the second sound 
of heart ; much prostration. 

12th. She complained yesterday of slight chilliness, 
and desired to be covered up, at which time there was 
marked blueness of the lips and nails. This was followed 
by fever, which continued through the night, producing 
great restlessness, with thirst, sharp heat, and dryness of 
skin, which latter symptoms were relieved at irregular 
intervals by profuse but transient sweats; prostration 
very great; pulse one hundred and sixty; respiration 
forty-five ; fine, dry crepitant rale of pneumonia from 
the summit of the right lung to the middle of the sea- 



ILLUSTRATIVE CASES. 117 

pula. Took about six ounces of blood from the arm, 
and directed the compound nitrous powder, antimony, 
to the extent of toleration, every three hours, and wine 
of colchicum. 

IQtJi. Respiration twenty-eight; pulse one hundred 
and twelve ; the redux rattle of convalescent pneumo- 
nia over the posterior face of the right lung ; murmur 
with the second sound of the heart less marked. Final- 
ly, this child recovered perfectly with the exception of 
a faint roughness, which may still be heard with the 
second sound of the heart. 

Remarks. — Throughout this prolonged attack, the 
urine exhibited now and then only the usual febrile 
excess of the opaque granular lithates of soda, lime, and 
magnesia, with some extractive matters ; but the renal 
secretions at no time furnished any special indications 
for treatment. It is especially worthy of note in this 
case, that without any renewed exposure, the child 
having been kept in bed and closely watched from the 
first day of its seizure, a pneumonia sprung up thirty- 
four days from the date of the attack, there being not 
the slightest assignable cause for the engorgement, ex- 
cept a transfer of the inflammatory process from the 
fibrous tissues of the bronchi to the surrounding pa- 
renchyma. 

The occurrence of otalgia, first in one and then in 
the other ear, with contemporaneous subsidence on both 
occasions of the annoying cough, as well as the return 
of the bronchial irritation when the earache ceased, can 
only be satisfactorily accounted for by supposing a 
metastasis of the rheumatic principle from the fibrous 
tissues of the bronchi to the fibro-cartilaginous structures 
of the internal ear. 



ANALYSIS OF CASES 



In nine out of twenty-seven cases of fibrous bron- 
chitis, the individuals had labored under rheumatism 
at some former periods of their lives; but the remainder, 
as far as could be ascertained, had never suffered from 
this disease in any form. Of the whole number of cases, 
thirteen happened in the winter, six in the spring, 
seven in the autumn, one in June, and none in July 
and August. At the time of seizure, one patient labored 
under phthisis of ten years' standing, two under old 
valvular alteration of the heart, and three had slight 
emphysema. 

The bronchitis was idiopathic in seventeen cases, 
while in ten examples it was preceded by rheumatic 
inflammation in some one of the white or fibrous tissues. 

There was more or less endocardial murmur in eleven 
cases. Pleuritis supervened in five, and pericarditis 
was observed in four. In six examples of idiopathic 
bronchitis complicated with cardiac lesion, the murmur 
was with the second sound alone in three, and with the 
first sound alone in one, while in two others both sounds 
were either prolonged or otherwise altered in character. 
But out of five cases in which the bronchitis was symp- 
tomatic of general rheumatism, there was a murmur 
with the first sound of the heart in three, with the 
second sound in one, and with both sounds in one. It 



120 ANALYSIS OF CASES. 

is therefore probable, although the number of cases is 
insufficient to draw any positive inference, that in gene- 
ral rheumatism the mitral valve is most frequently 
implicated, while in fibrous bronchitis the rheumatic 
element is more apt to attack the semilunar valves. 

In two out of six cases of idiopathic bronchitis, asso- 
ciated with cardiac lesion, the murmurs were recognized 
during the first week; in two during the second week; 
in one during the third week, and in one on the thirty- 
second day of the disease. 

In three out of the ^ve symptomatic cases, the bron- 
chitis took precedence of the cardiac lesion, which latter 
was in each example symptomatic also of foregone rheu- 
matism in other white tissues. It may be remarked, 
that many of these cases were selected because the 
cardiac lesions bore incontestable evidence of the rheu- 
matic character of the bronchitis. The examples, there- 
fore, furnish no e\ddence of the mean frequency of 
cardiac complication, which does not occur oftener, 
probably, than in one out of four or five cases. 

Pneumonia complicated the bronchitis in twelve cases. 
In seven of these the engorgement was limited, being 
conQned to a few lobules, and not exceeding in any 
instance the space which a large orange might have 
occupied. In five cases, the engorgement was largely 
difi'used throughout one or more lobes. 

In eight cases, the pneumonia was recognized both by 
auscultation and the signs furnished by the sputa. In 
two, the ear detected the engorgement, other signs fail- 
ing ; and, in one, the sputa were rust-colored when other 
signs gave no evidence of vascular lesion. 

The pneumonia commenced during the first week of 
the bronchitis in eight cases ; within the second week 
in two ; in one on the twentieth, and in one other on 
the thirty-fourth day of the disease. 



ANALYSIS OF CASES. 121 

Five of the individuals treated for fibrous bronchitis 
suffered, on different occasions, with rheumatic inflam- 
mation of the white tunic of the eyes ; but only two 
of these ever labored under articular or general rheu- 
matism. It is, therefore, probable that persons prone 
to rheumatic sclerotitis, are also peculiarly subject to 
fibrous inflammation of the bronchi. 

In three examples, one of which is noted amongst 
the foregoing cases, the cough ceased at various inter- 
vals during the course of the bronchitis, and the indi- 
viduals, all children under seven years of age, were 
attacked with severe earache. In one example, during 
an attack of six weeks' duration, there was a transfer 
of the rheumatism to one or the other ear on four dis- 
tinct occasions. The cough ceased entirely as soon as 
the otitis commenced, and returned again, in every in- 
stance, on the cessation of the earache. In one of these 
cases, the otalgia seemed to be aggravated by sound ; in 
two, the earache was followed by marked deafness^ 
lasting for several days only; and, in one, there was a 
slight sero-ceruminous discharge ; but in no instance 
was the inflammation followed by true otorrhcea. These 
cases of otalgia depended, probably, on rheumatism 
seated in one or more of the articulations uniting the 
malleus, incus, orbicularis, and stapes, or at the point 
of union between the first and last-named bones with 
the external and internal drum membranes. May not 
neglected cases of this sort lead, in some instances, to 
permanent deafness? 

A very large proportion of the cases were induced by 
exposure of the body to wet or dampness at a low tem- 
perature. 

The symptoms most strikingly characteristic of the acute 
variety of rheumatic hronchitis are profuse, irregular 
sweats, inordinate sensibility to cold, transient flushings of 



122 ANALYSIS OF CASES. 

the face^ and either a constant or a paroxysmal and un- 
productive cough. 

In fibro-bronchitis, simple or complicated with pneu- 
monia, the sweats are symptomatic, and differ widely 
from the critical perspirations which, happening either 
as cause or effect, announce so frequently the favorable 
termination of simple inflammatory engorgement. And 
both of these sweats are again easily distinguishable 
from the night-sweats of phthisis. 

In ordinary pneumonia, the flushing of the cheeks is 
generally deep, circumscribed, and constant; but in 
rheumatic bronchitis, on the contrary, the redness of 
the face is generally faint, transient, and irregular. 
When, however, extensive pneumonia supervenes in 
these cases, the capillary congestion about the face is 
both deep and persistent, and generally proportionate 
to the degree of engorgement. 

In subacute fibro-bronchitis, the pulse and respiration 
are usually not more frequent than in health, and gene- 
rally there is neither pain in the chest, nor the post- 
sternal soreness, which so frequently accompanies the 
dry stage of ordinary mucous catarrh; but often, during 
the act of coughing, more or less pain is felt, accompa- 
nied with a sense of soreness, as if the bronchi were 
suddenly scraped by some rough instrument. The acute 
variety of the disease is attended by a more or less fre- 
quent and corded pulse. The frequency of the respira- 
tion is generally governed by the amount of supervening 
engorgement, and, as the pneumonia is usually limited, 
the average respiration, in a given number of cases, is 
less than in ordinary congestive pneumonia. There is 
usually no fixed pain or soreness about the chest, but 
both are sometimes felt during the act of coughing. 

The rapid evaporation from the surface occasions, in 
the disease under consideration, the most acute sensi- 



ANALYSIS OF CASES. 123 

bility to cold ; the reverse is the case in ordinary pneu- 
monia. 

Mucous catarrh, Hke coryza, is generally extremely 
limited in its duration; but fibro-bronchitis, degene- 
rating into a chronic disease, may last for months, or 
even years. In muco-bronchitis, the follicles pour out 
an abundant mucous secretion ; but in fibro-bronchitis, 
on the contrary, the cough is either dry, or the matter 
expectorated is serum, highly charged with albumen. 
A highly aerated* sputa, resembling the white of egg 
when beaten into whips, occurs in some few extremely 
acute cases of rheumatic bronchitis. This results from 
much cough and a rapid respiration, whereby the albu- 
minoid serum is subjected to a sort of churning process. 

In two cases of subacute rheumatic bronchitis, the 
paroxysmal cough ceased entirely, in one example for 
two, and in the other for more than three days, owing 
to an eruption on the surface of roseola. In one of these 
cases, the cough returned on the cessation of the exan- 
thema. In one instance, the disease was associated with 
urticaria, and, in one other, with simple erythema. 

The auscultatory signs, with the exception of an oc- 
casional sibilant rale, are entirely negative ; so that, so 
far as these are concerned, the disease has to be made 
out, in most cases, solely by the method of exclusion. 
Where, however, pneumonia sets in, it becomes a most 
important sign of the pre-existing bronchitis, since it 
can generally be recognized either by the sputa fur- 
nished, or by the ear ; and thus, indirectly only, auscul- 
tation becomes an important mode of determining the 
parent disease. The supervention of cardiac lesion is 
also of great value in pointing out the true character of 
the bronchitis. Moreover, rheumatic inflammation has 
probably a large ' share in the production of both nar- 
rowing and dilatation of the bronchi, particularly the 



124 . ANALYSIS OF CASES. 

globular form of expansion, the fibrous and cartilaginous 
structures of these tubes undergoing, during the inflam- 
matory process, the same plastic transformation which 
is observed to take place in the white tissues of the 
body generally. Dr. Williams, as the reader is aware, 
has traced the origin of dilated bronchi to the influence 
of pleuro-pneumonia. Now, we believe, that pleuro- 
pneumonia cannot, of itself, induce dilated bronchi; 
but that a pleuritic effusion compressing a lung, the 
fibrous and cartilaginous tissues of ichich are softened 
and rendered plastic hy pre-existing rheumatic inflammar 
tion, may, and does aid in the production of dilated 
bronchi, we are not disposed to doubt. And we are, 
moreover, induced to think that the structural altera- 
tions of the bronchi, observed by Dr. W., were the 
result of fibro-bronchitis, associated, as it so often is, 
with rheumatic pneumonia and pleuritis. 

Fibrous bronchitis serves also to explain the formation 
of the plugs or concretions of amorphous semiorganized 
matters, which, occasionally blocking up the bronchial 
tubes, are sometimes, though very rarely, expectorated 
in cylindrical or columniform masses. Where a lung 
labors under muco and fibro-bronchitis, occurring con- 
temporaneously, with or without symptomatic pneu- 
monia, the products of these associated conditions are 
serum, exudation matter or lymph, mucus, and albumen, 
the commingling of which go to form the concretions in 
question. 

As to the frequency of fibro-bronchitis, it is believed 
that as catarrh occurs sporadically, the rheumatic variety 
will be found in about ^ve out of twelve cases, but that 
during epidemics of influenza, the rheumatic element will 
be recognized in a smaller proportion of cases. It is be- 
lieved, also, that the cartilaginous and fibrous structures 



ANALYSIS OF CASES. 125 

of the bronchi are more frequently the seats of rheumatic 
inflammation than any other white tissues of the body. 

In acute fibro-bronchitis, the exacerbations of cough 
occur usually during the night, while in the subacute 
variety of this affection this symptom is generally most 
troublesome during the day. In the subacute and chronic 
forms of the disease, the skin is usually pre ternatur ally 
dry; but if an acute attack supervene on the chronic 
affection, it is generally attended by mild perspirations. 
In acute broncho-pneumonia, the blood was uniformly 
found more highly buffed than in simple inflammatory 
engorgement, but not more largely charged with fibrin 
than it occasionally is in some severe cases of pleuro- 
pneumonia. 

In the acute variety, uric acid and urate of soda are 
found in excess in the urine, unless the kidneys refuse 
to secrete them, and then the absence of these salts in 
the urine is generally an index of their superabundance 
in the blood. 

In the subacute and chronic forms of the disease in 
question, urates of soda and lime are almost constantly 
found in the urine in very great excess. Earthy phos- 
phates exist occasionally under all forms of this disease. 

In simple uncomplicated pneumonia, there is generally 
no antecedent cough, and the auscultatory signs of en- 
gorgement are amongst the earliest evidences of pulmo- 
nary mischief; but the variety symptomatic of fibro- 
bronchitis is usually preceded for some time by the dry 
characteristic cough already described. Not unfrequently, 
however, the bronchitis and engorgement happen con- 
temporaneously. 

Individuals laboring under simple inflammatory en- 
gorgement recover generally in four, eight, twelve, or, at 
most, twenty days, according to the extent of the pneu- 
monia and the time at which it comes under care; but 



126 ANALYSIS OF CASES. 

where this affection is complicated with or depends on 
pre-existing bronchitis, the engorgement, if it does not 
result in death, may continue for thirty-five days or 
more, and occasionally, though very rarely, degenerate 
into chronic pneumonia. 

Now, it seems very clear that before symptomatic 
pneumonia can recover, the bronchitis on which it de- 
pends, and to which it owes its origin, must be relieved. 
And this suggests the inquiry: If the bronchitis were 
suitably treated before the pneumonia sets in, might not 
the engorgement which complicates these cases so sadly, 
and adds so materially to their danger, be prevented 
effectually? It is believed that future inquiries must 
answer this question in the affirmative, if indeed it is 
not answered already. 

Grisolle, the faithful and indefatigable recorder of 
morbid phenomena, tells us^ that of tvio hundred and 
one patients from whom he was enabled to procure a 
satisfactory antecedent history, seventy-six had coughed, 
for a greater or less length of time, before the develop- 
ment of symptoms clearly characteristic of pneumonia. 
Of these seventy-six, twenty-three had labored under the 
chronic form of bronchitis for years ; in the remaining 
fifty-three, the bronchitis had existed three or four 
weeks at the time of pneumonic seizure. The proportion 
of these cases seemed to M. Grisolle somewhat greater 
in males than in females, doubtless because the former 
were most exposed during inclement seasons. Excluding 
the twenty-three chronic cases, Grisolle's observations 
show that fifty-three, or more than one-fourth of his 
two hundred and one cases of pneumonia, were preceded 
by acute bronchitis. Now, from all that we have seen, 
no reasonable doubt can be entertained that these were 

^ Traite Pratique de la Pneumonie, p. 182. 



ANALYSIS OF CASES. 127 

nearly all cases of fibro-bronchitis, and that a large num- 
ber of the Supervening attacks of pneumonia might have 
been prevented by ordinary care of, suitable attention to, 
or appropriate treatment directed to the primary bron- 
chitic lesion. Again, Grisolle says (p. 183) : "Les mois 
de juillet, d'aout, de septembre et d'octobre ont ete les 
seuls pendant lesquels je n'ai pas vu la bronchite pre- 
c^der I'inflammation du poumon ; dans tons les autres 
mois la proportion est restee a pen pres la meme pour 
chacune d'eux." This goes to show that, during the hot 
and dry months, the pneumonias were not preceded by 
bronchitis, but that, in the cold and wet seasons, bron- 
chitic lesions were common antecedents. The statement 
therefore renders it extremely probable that the catarrhs 
observed by him were rheumatic in their character, it 
having already been shown that the cases which form 
the basis of our remarks were, in nearly every instance, 
produced by exposure to cold and dampness. Under 
this view of the subject, it is not well to fall in with the 
received opinion, and to believe, with Walshe and others, 
" that, in the adult, idiopathic inflammation of the tubes 
does not pass on to the parenchyma;" but rather, taking 
the facts of the case in their correlative signification, 
entertain a hope that more accurate diagnosis may yet 
enable us, in many cases, by timely advice, to prevent a 
disease which numbers so many victims, and one which, 
under the best directed management, must so often prove 
fatal. 

These things teach us a practical rule — that patients 
laboring under ordinary mucous catarrh, may be per- 
mitted to go about and do as they like; while others, 
having even the mildest form of fibrous bronchitis, 
should be counselled to avoid all the causes likely to 
induce a secondary lesion about the heart or lungs. 

It is remembered by all that the eminent observers 



128 ANALYSIS OF CASES. 

Laennec and Andral differed very widely on one or two 
points connected with the pathology and symptomatology 
of chest diseases. These differences arose out of the 
oOth, 31st, 32d, 33d, 34th, and 35th cases of Andral, 
and certain other examples given by him, of pulmo- 
nary engorgement without auscultatory signs. Laennec 
thought that the ear could detect a pneumonia, in what- 
ever part of the lung it might be seated; he had seen 
but one instance to the contrary, and in that, he says, 
the engorgement might have been detected, had he list- 
ened at the right time. Andral entertained a different 
opinion, and has given cases where neither auscultation, 
percussion, nor the expectoration, gave any clue to the 
disease. Indeed, whenever pneumonia starts up late and 
unexpectedly in other acute chest affections, it is gene- 
rally assumed, even when auscultation and percussion 
have failed in detecting it, that a latent or central en- 
gorgement must have previously existed. 

Now, with the view of reconciling these discrepancies, 
it may be asked, where, in most cases, is the necessity 
for such an assumption, when it is shown by the pre- 
vious cases that inflammation may extend, at any time 
during the course of a fibro-bronchitis, directly to the 
parenchyma of the lung ? 

Amongst faithfully recorded observations of others, it 
is easy to recognize cases of fibro-bronchitis associated 
with pneumonia; but the authors, so far from explain- 
ing the etiology of these cases, have failed even to refer 
them to their true anatomical seat, or to throw out the 
remotest hint that they owe their origin to a rheumatic 
law. In Andral's C Unique, under the head of Pneumo- 
nia, we may refer for example to observations 2, 5, 7, 
20, 23, 28, and 37, all of which must unquestionably 
have been cases of rheumatic bronchitis, associated with 
pneumonia. 



TREATMENT. 129 

Fibro-bronchitis is often, without doubt, the most 
insidious disease under which a patient can possibly 
labor. It may last, in a subacute form, for days, weeks, 
or months, without giving rise to any greater annoyance 
than that which is produced by a dry cough, attended 
occasionally with slight pain and soreness. The indi- 
viduals laboring under it feeling no indisposition, having 
a good appetite, and sleeping well, go about attending 
to their occupations as usual. With ordinary care, and 
an avoidance of exposure at night and during wet 
weather, the disease, unaided, frequently ends in recovery ; 
but a very slight exciting cause, fatigue, over-indulgence 
in food and wine — particularly when these are taken at 
night — exposure to dampness, or some other trivial 
causes, often at once convert this mild affection into an 
acute bronchitis. On this pneumonia frequently super- 
venes, giving rise to one of the most dangerous compli- 
cations under which an individual can labor. But still 
mare frequently acute bronchitis, with contemporaneous 
or subsequent engorgement, happens suddenly, without 
being announced by the cough, and other antecedents 
which mark the subacute form of this affection. 



TREATMENT OF FIBRO-BRONCHITIS AND RHEUMATIC PNEU- 
MONIA. 

First of all, it is of leading importance, as before 
explained, to adopt such means as are likely to alter 
and control the particular condition of the fluids, which, 
having given rise to, may serve, without correction, to 
perpetuate the morbid action. In all cases of this affec- 
tion, and especially those attended by profuse sweating, 
it is very indispensable to see that the drinks and diet 
of the patient are well supplied with common salt — 
9 



130 TREATMENT. 

muriate of soda. In long-continued attacks of most 
acute diseases, sugar is too often used as a condiment in 
place of table-salt. Many object to the use of chemical 
remedies for rheumatism, on the ground that, if they 
did any good, they ought to cure in all cases, without 
the aid of other remedial agents. It would be just as 
philosophical to announce, that it is useless to give the 
appropriate antidote for oxalic acid, or any other poison 
taken into the stomach, because when this has been 
done, a resort to bleeding, cups, leeches, and demulcents, 
is still required to relieve the gastric inflammation. 

The next indications are: 1st. To reduce plethora, 
whereby congestions are removed, the injecting force of 
the heart and arteries restrained, and the circulation, or 
rather the complex series of elastic pouches, through 
which it is carried on, are enabled, by a series of 
siphonic acts, to take up and remove the transfused 
serum which may occupy the cellular tissue surround- 
ing the points of congestion. 2d. To use such catalytic 
agents as are best calculated to relieve the inflammatory 
conditions of blood, and, by their antiplastic effects, 
prevent the organization of coagulable lymph, od. By 
the use of anodynes to calm the irritability of the nervous 
system, quiet the cough, and thereby give partial rest 
to the inflamed bronchi and engorged parenchyma. 

Deplethn. — Most writers agreeing as to the signal 
advantage from loss of blood in pneumonia, only differ 
in regard to the quantity to be taken, and the time and 
mode of its abstraction. In simple, uncomplicated con- 
gestive pneumonia, it is often difficult, owing to the 
supervention of syncope, even when the patient is 
recumbent, to take blood in sufficient quantity, by 
one or two bleedings, to make any decided impres- 
sion on the disease. In order, therefore, to relieve the 
congestive inflammation under which the lung labors. 



TREATMENT. 131 

the bleedings, in this form of the disease, have to be 
frequently repeated, or the blood has to be taken bj 
leeches, so that from its gradual withdrawal the brain 
may be, as it were, insensible to its loss. The danger 
here is not from taking too much blood, but from 
the difficulty often experienced in procuring a suffi- 
cient quantity in time to affiDrd relief; this difficulty 
may be overcome, in many cases, by the use of brandy 
and other stimuli; and where the patient has labored 
under remittent fever the previous autumn, or has 
his system impressed at the time by marsh-poison, the 
conjoint free use of quinia is indispensable, and will, 
under these circumstances, in most cases, relieve the 
engorgement without a resort to the lancet. Being 
satisfied of the existence of pneumonia by auscultation, 
the frequency of the respiration, or the character of the 
sputa, we bleed in this variety of the disease because, 
from want of sufficient nervous energy, the circulation 
has lost its reactive force, is incapable of moving the 
normal amount of blood from the central to the peri- 
pheral vessels; and still less has it the power to hurry 
on and remove the blood from the seats of congestion. 
To enable it to do either, it is necessary to diminish the 
quantity of the circulating current, q,nd give tone to the 
nervous system. Those who are governed in these cases 
by the state of the pulse alone, are apt to delay bleed- 
ing until, on the last day of the attack, pain in the side, 
and increased force in the pulse, announce a pleuritic 
or bronchitic complication, for the relief of which bleed- 
ing can no longer be adopted with any certainty of 
success. This form of pneumonia is most apt to occur 
during the prevalence of epidemic influenza, when the 
attacks are less likely to be complicated with other 
inflammations, but are more generally associated with 
greater or less adynamia, rendering it impossible for us 



132 TREATMENT. 

to bleed at all, in many cases, without a previous resort 
to stimulants. In this condition, where the early loss 
of blood is found so salutary, the plan of bleeding ad- 
vised by Bouillaud is the best, simply because, in many 
cases, none other is practicable, it being rarely possible, 
during the prolonged stage of congestion, to get any 
more blood at the first or second attempts, than he 
advises should be taken ; and hence the necessity for 
moderate bloodletting, often repeated. When, however, 
blood can be procured, it is much better to take it 
in large quantities as early as possible in the disease. 
One or two bloodlettings, to the extent of twenty or 
thirty ounces, practised within twelve or twenty-four 
hours from the date of seizure, not only establishes a 
speedier convalescence, but accomplishes the purpose 
much better than a loss of twice or thrice as much 
blood, taken by small and often-repeated bleedings. 

The remedies next most useful in this form of the 
disease, are the stimulating expectorants and diapho- 
retics, mild purgatives, and ipecacuanha. Calomel is 
seldom required, and, unless in this condition it be given 
with great care, its exhibition is apt to be followed by 
ptyalism, which should be carefully avoided. Antimony 
may also be used to the extent of producing, at each 
dose, slight nausea, except in malarious districts, where 
the nervous systems of the individuals are depressed by 
the action of marsh-poison. Under these circumstances, 
the administration of antimony is little less than mur- 
derous. 

Congestive pneumonia has merely been referred to, in 
order to establish points of comparison between engorge- 
ment having its origin in the depurative capillaries, and 
the more acute, or rheumatic variety of the disease, in 
which the bronchial or nutritious arteries are primarily 
concerned. In the one case, the congestion precedes 



TREATMENT. 133 

the inflammation, while, in the other, the reverse is the 
case, the inflammatory lesion preceding the engorge- 
ment. 

When either lesion supervenes on the other, it is well- 
nigh too late, in many cases, to resort to bleeding with 
an expectation of the great advantage which might have 
resulted from its earlier employment. For, while the 
timely loss of blood may, in every instance with cer- 
tainty, cut short the primary mischief singly, the po- 
tency of depletion to relieve the original disease, and at 
the same time control the secondary inflammation in 
the one case, and the supervening engorgement in the 
other, is far less absolute. While, however, loss of blood 
is often powerless in combating the double lesion, as it 
might have done either singly, a resort to free depletion 
is not only justifiable but proper here, as it is at all 
other stages of the disease. 

As intermediate between con2;estive enorors^ement and 

O Co 

rheumatic or broncho-pneumonia, we might speak in 
this place of simple, frank, inflammatory pneumonia, 
where the capillary vessels of the depurative circula- 
tion, and the terminal nutritious arteries feeding the 
air-cells, are both probably equally concerned from the 
beginning; but as it is not our purpose to furnish a 
treatise on pneumonia, but simply to call attention to 
one form of the disease, the force of what we have to 
say would only be weakened by allusion to other va- 
rieties. • 

In uncomplicated acute idiopathic fibro-bronchitis, 
there is generally an active play of the pulse and much 
sweating ; the symptoms, with the exception of cough, 
not difiering very materially from those which accom- 
pany acute rheumatic inflammation in other white tis- 
sues. But the disease under consideration affecting 
organs essential to life, the demands for efficient treat- 



134 TREATMENT. 

inent are proportionate in importance to the value of 
the structures involved. Moreover, it is liable to be be- 
set by dangerous complications, pneumonia, endocardi- 
tis, pericarditis and pleuritis. Nay, more, it sometimes 
involves the fibro-serous tissues covering the brain and 
spinal cord. It numbers probably as many victims as 
any other affection, and, where life is not directly en- 
dangered by an attack, it often leads to serious structural 
alterations both of the heart and lungs. 

Bleeding in this affection is of prime importance, not 
for the object assigned when speaking of congestive 
pneumonia — that of unloading the over-distended capil- 
laries of the depurative circulation — but to control the 
propulsive force of the heart and arteries, and thereby 
overcome the inflammatory process going on in the 
white tissues of the bronchi, which are directly fed by 
the nutritious vessels. When, however, a sympathetic 
remora of blood taking place in the depurative circulation, 
gives rise to engorgement in the surrounding parenchyma, 
bleeding exerts the double effect of relieving congestion 
and controlling inflammation at one and the same time. 
Loss of blood is, therefore, of the first consequence both 
in preventing and relieving the morbid catenation, and 
it is all important that one or two free bleedings be per- 
formed early in the disease. If earlier and freer deple- 
tion had been practised in Cases II., Y., YI., and XII., 
there is hardly a doubt that they would have been 
attended by better results. 

Where there isH*ti. reason to apprehend the contempo- 
raneous occurrence of rheumatic bronchitis and exten- 
sive engorgement in the same lung, it is still more 
important, in view of the sympathetic and reciprocal 
morbid action of these two conditions on each other, 
that the freest depletion be practised at the very outset 
of the conjoined affections. Under these circumstances, 



TREATMENT. 135 

the patient, if too weak to sit up, should be placed in a 
semi-recumbent posture and bled to syncope. If the 
quantity of blood obtained be too small, the operation 
should be soon repeated ; diffusible stimulants, if neces- 
sary, being given to rouse the circulation, so that a 
sufficient quantity of blood may be had to remove con- 
gestion and control inflammation. 

Mercury. — The remedial agent which comes next to 
the lancet, in fibro-bronchitis, associated or not with 
symptomatic or contemporaneous idiopathic engorge- 
ment, is calomel. It should be given in full doses of ten 
or twelve grains once in the twenty-four hours, for the 
three or four first days of the seizure, or in doses of two 
or three grains every three or four hours, associated with 
about the same quantity of ipecacuanha. From five 
to fifteen grains of nitrate of potassa may often be 
added with advantage to each dose. If the cough is 
troublesome, repose should be given to the lungs by a 
full dose of Dover's powder, black drop, opium, or some 
other anodyne, at night. If a joint labors under inflam- 
mation, it can be placed in a state of absolute quiet, and 
the doctrine of rest, as advocated particularly by the late 
Dr. Physick in the treatment of disease, can be carried 
out to the letter. But with the heart and lungs the case 
is quite different; these organs, being constantly required 
to work, can never be kept in a state of rest (unless from 
the supervention of pleuritic effusion on inflammation of 
the lungs), and this constitutes one of the chief obstacles 
to the successful management of acute affections in these 
structures ; nevertheless, partial or comparative repose 
may be procured in the diseases of both, by anodyne, 
sedative, and antispasmodic agents. Colchicum may be 
used here as in the treatment of other forms of rheuma- 
tism; but in this affection its exhibitions are seldom 
followed by the marked beneficial results which are 



136 TREATMENT. 

obtained from its use in gout. Digitalis is of great value 
in controlling the action of the heart and arteries, and 
often saves the necessity for large and repeated losses of 
blood. The tincture prepared from the European fox- 
glove is the best, and may be given in doses of ten drops 
every six hours, so long as the rate of pulse is above 
eighty ; if, however, the ratio of its beats falls below this 
standard, the digitalis should be pretermitted for a time, 
and resumed again as occasion may require. 

In uncomplicated fibro-bronchitis, antimony is of no 
value whatever, and its use is to be as little thought of 
as in the treatment of articular or any other form of 
rheumatism. Where, however, extensive engorgement 
supervenes, this agent may be given so long as moderate 
doses produce nausea; but w^hen the stomach tolerates 
it, ij)ecacuanha alone, or combined wdth calomel, may be 
advantageously substituted. 

Having referred to the use of calomel, antimony, and 
opium, in two distinct forms of pneumonia, it may be 
w^ell to say a word or two as to the action of these reme- 
dies, and, at the same time, notice the conditions which 
'l^t.^ciM often, tinder their employment, .proved advantageous or 
otherwise. 

Successful management of disease must ever depend 
on accurate diagnosis, not only of the pathological lesion, 
but also of the conditions which accompany it. This 
knowledge and familiarity with the action of remedies, 
are the only guides by w^hich the physician can, with any 
degree of certainty, prescribe particular agents for the 
relief of special morbid actions or conditions. 

The calomel and opium treatment for pneumonia, of 
British practitioners, and the almost exclusive use of 
antimony by the French, seem to stand w^iere they ori- 
ginally did; each class abjuring the practice of the other, 
still doggedly adheres to its own favorite methods. 



TREATMENT. 137 

But the treatment of pneumonia is a grave question, and 
it is to be hoped, for humanity's sake, that no atom of 
prejudice will ever be permitted to interfere with well- 
directed efforts to discover, establish, and make universal 
the best mode of management. 

Grisolle, who, differing from most French writers, de- 
votes nearly one-third of his work to treatment, does not 
appear to have prescribed calomel in a single case, since 
he says that he has no personal experience of the calomel 
and opium treatment of the English physicians, and calls 
upon them for evidence in its favor. It would be better 
for the advocates of each method to try the plan of the 
other; but, in order that their patients may not die from 
nervous prostration induced by antimony on the one 
hand, nor suffer from the much-dreaded effects of calomel 
on the other, let them both see, in making the trial, that 
they select suitable cases for the application of each 
method. 

As exclusive modes of treatment for all forms of pneu- 
monia, and as applied to the various conditions of the 
patients in whom this disease may occur; whether asso- 
ciated with anemia, plethora, or adynamia, &c., it would 
be difficult to say which of the two methods is the best, or 
rather which is most objectionable. As exclusive modes, 
neither is better, probably, than homoeopathic treatment, 
or M. Biett's "let alone" system; but as applied to parti- 
cular but distinct classes of suitable cases, in relation to 
special and like conditions of the individuals in whom 
they occur, both methods are perhaps unexceptionable. 

Of the conjoined employment of ipecacuanha and calo- 
mel we might say much, but as to the combined and 
continued use of calomel and opium in pneumonia we 
can say nothing. Each of the latter is useful, in its way, 
in controlling certain symptoms and as applicable to cer- 
tain conditions, but both ought rarely to be united in the 



138 TREATMENT. 

same formula, unless with the direct intention of pro- 
ducing salivation. Where, however, there are indications 
for each to fulfil, they may be given at the same time, 
guarding their combined effects by the use of ipecacuanha 
or antimony, which latter very materially diminishes the 
liability to ptyalism. 

Crude opium should not be given in pneumonia, where 
a depressing effect is desired, because it contains narco- 
tine, which is proved to be a tonic like quinia; and 
also thebaia, an alkaloid said to have the properties of 
strychnia. 

Opium and its preparations should be dispensed with 
as general remedies for pulmonary engorgement, because 
their immediate effects are to quicken respiration, be- 
sides adding force and frequency to the heart's action. 
They are farther objectionable; for, while they produce 
sweating, all other secretions are arrested, particularly 
those from the alimentary canal, and thus effete matters 
are retained, an evil not compensated for by their dia- 
phoretic properties. They should be altogether avoided 
where there is much fever and heat of skin, with dry- 
ness of tongue. They produce congestion of brain, and 
should not therefore be given when, from engorgement 
of the pulmonary parenchyma, the vessels of the head 
are already replete with blood. 

They may be given, after suitable evacuation of 
blood, to relieve the violent pain of pleurisy, and to 
control the distressing cough so often attendant on 
fibro-bronchitis ; but where these diseases are associated 
with any degree of engorgement, it is often well to use 
hydrocyanic acid combined with some other narcotic or 
sedative, which will not arrest the secretions. 

In fibro-bronchitis, attended with fever and sweating, 
opium may be united with calomel without the risk of 
ptyalism ; but in congestive pneumonia, where the pulse 



TREATMENT. 139 

is often depressed, the conjoined use of these remedies 
will often produce salivation. 

The effects of calomel are, first, its action on the 
stomach, producing slight nausea and sweating. Secondly, 
through its action on the alimentary canal and secreting 
organs related therewith, it is at the same time revul- 
sive, depletive, derivative, and sedative. Thirdly, it acts, 
as an antiplastic on the blood, impoverishing it, and 
preventing the elaboration of coagulable lymph. Fourthly, 
it has the catalytic property of softening and slowly 
disorganizing structures of low vitality, as recently or- 
ganized lymph, or the gums, producing ptyalism. Now, 
it is highly advantageous in many cases to procure the 
primary, secondary, and tertiary effects of calomel, and 
at the same time avoid its quaternary and distinctive 
effects. On the other hand, it is often desirable to 
induce the disorganizing action of mercury in breaking 
down recently-formed and slightly organized indurations, 
or the adhesions resulting from recently-vitalized coagu- 
lable lymph; and this can be done without subjecting 
the patient to the annoyance and depression which 
would result from the primary effects of the remedy. 
And, moreover, by properly estimating the condition of 
the patient, regulating the dose, and giving it with or 
without opium, the primary effects may generally be 
brought about at pleasure, without danger of inducing 
its disorganizing action. By uniting opium with calo- 
mel, its salivary effects may generally be induced, but 
by combining with it ipecacuanha, ptyalism may usually 
be obviated. In broncho-pneumonia, attended by a fre- 
quent pulse and free perspiration, calomel may be given 
freely, and continued for days without danger of pro- 
ducing ptyalism, especially if the patient be enjoined 
not to depress the action of his gums by taking cold 



140 TREATMENT. 

drinks, and his bed be so placed that a draught of cold 
air cannot pass over his fiice. 

The well-known influence of cold in acting as the 
exciting cause of ptyalism, induced the writer to experi- 
ment, with the view of ascertaining how far extremes 
of temperature might be made available in causing the 
action of mercury to impinge on a particular part. 
Thus far he has only applied it to the treatment of the 
cartilaginous-like buttons which often form about the 
prepuce and corona glandis, as a result of neglected 
primary syphilitic ulcers, and to open chancres w^ith 
indurated bases. These morbid productions have only 
a parasitical existence, and it appears to be owning to the 
feebleness of their vital endowments that the catalvtic 
power of mercury and iodine exerts a control over them. 
So long as these indurations remain, they are never- 
failing sources of syphilitic infection to the whole sys- 
tem, giving rise, under modifying circumstances, to the 
varied forms of secondary eruptions ; but let them be 
cut out or destroyed, and the disease is sometimes cured, 
and farther infection of the system prevented. 

In a number of instances I have directed patients, 
Avhose systems have been previously mildly impressed 
by mercury, to cover or surround the induration with 
ice and salt, for a period sufficient to give the parts 
adjacent a sense of numbness. When this had acted 
sufficiently, they were directed to let the part resume its 
natural temperature, and then place it in a warm poul- 
tice. This process was sometimes repeated every second 
or third day. Thus far the trials have been attended 
with happy results, but how far these were owing to 
changes of temperature alone, or to the local action of 
mercury supposed to be thus induced, it is difficult to 
say. 

There is something in the highly fibrinous condition 



TREATMENT. 141 

of the blood attending acute, serous, arthritic, and fibrous 
inflammations, which seems to antagonize almost com- 
pletely the ptjalizing action of mercury; while in nor- 
mal, ataxic, and asthenic states, and in patients laboring 
under congestion, the reverse is the case. In the for- 
mer conditions mercury will seldom salivate, whether 
united with opium or not; and where the latter medicine 
has been given with ipecacuanha, in the form of Dover's 
powder, I have never, under the circumstances, met with 
an instance of ptyalism. 

Antimony. — The treatment with antimony applies 
particularly to cases of pneumonia in which there are 
heat and dryness of skin, a parched tongue, persistent 
and circumscribed flushing of the face, and considerable, 
force of pulse. It does not apply to cases in which there 
are redness of the tongue, a languid pulse, much sweat- 
ing, with coolness of skin, transient and diffused flush- 
ings of the face, and adynamia, the existence of which 
last condition is generally better characterized by unusual 
size of the pupils when compared with those of other 
individuals exposed to the same degree of light. Still 
less ought this agent to be given when, from the shock 
inflicted on the nervous system by the occurrence of 
engorgement, or other cayses, the patient labors under 
any degree of nervous prostration. And where indivi- 
duals attacked with pneumonia have suffered from inter- 
mittent or remittent fever within a year or two, or 
have their nervous energies depressed by having resided 
in a malarious region without laboring under fever, 
antimony ought never to be given for the cure of pneu- 
monia, or any other affection. And as to the plan 
of Mr. Marryatt, and the contra-stimulant doctrine : 
where there is perfect toleration to antimony in large 
doses, its continuance should be persisted in with great 
caution; for while in many cases, under these circum- 



142 TREATMENT. 

stances, tartar emetic exerts no influence over the dis- 
ease, it will sap the powers of the nervous system, and, 
sooner or later, superinduce fatal nervous prostration. 

In the case of a man of good constitution, aged thirty- 
one, and laboring under fibro-bronchitis associated with 
engorgement of nearly the whole of the right lung, there 
was perfect toleration of antimony, in doses of four 
grains, repeated every three hours. After having con- 
tinued these doses for several days, they seemed not to 
make the slightest impression on the disease ; but it was 
manifest, from his extreme exhaustion, tremulous, feeble 
voice, dilated pupils, relaxed expression of the muscles 
about the face, and great apathy of mind, that the anti- 
mony had produced the worst degree of nervous ex- 
haustion, and, if persisted in, must cause death in a 
short time. The antimony was withheld, a little wine 
was given, and, after some hours, calomel and ipecacu- 
anha were given, of each five grains every four hours. 
Each dose produced slight nausea, little by little the 
patient's strength rallied, resolution of the engorgement 
commenced on the third day from the date of the new 
prescription, which was continued for about a week, and 
finally he recovered perfectly. 

There is not a doubt that many patients die from 
sedation produced by antimony, before tlie engorgement 
has time to be removed. 

The trials made by M. Louis show that in patients 
who were bled, and subsequently treated with tartarized 
antimony, the mean date of convalescence was about 
two days later than in those who only underwent vene- 
section. A result similar to this has been obtained by 
M. Grisolle, who found that out of seventy cases of 
recovery, treated by bleeding and tartar emetic, conva- 
lescence was established on the fourteenth day, being 
two days later than the average date of recovery in 



TREATMENT. 143 

patients who convalesced under bleeding only. But 
these results neither prove that the medicine exercised 
a happy or a prejudicial influence on the progress of the 
disease, for in all these cases several bleedings had been 
practised without benefit, the d'isease progressing in spite 
of them ; moreover, M. GrisoUe had bled one day later, 
and M. Louis two days later, in patients treated with 
antimony, than in those who took none of this medicine. 
Besides, M. Grisolle's seventy examples of recovery hap- 
pened out of a series of eighty cases, out of Avliich he 
lost only ten; a favorable result, which he lias the can- 
dor to attribute in great measure to the youth of his 
patients, their mean age being under thirty-six years. 

In another series of cases, thirty patients, of the average 
age of forty-nine, treated by M. Grisolle, had been so 
largely bled that all possibility of farther depletion was 
out. of the question; they all labored under great pros- 
tration, the pulse was soft and easily compressed, and the 
condition of one-half of them hopeless, when the use of 
tartarized antimony (the most improper agent which 
could, under the circumstances, have been given) was 
commenced. Eighteen, or nearly two-thirds of these 
thirty patients, died, more than one-half of the fatal cases 
terminating during the first two days; a conclusive proof 
that antimony is injurious in cases attended by adynamia 
and nervous exhaustion, and that its exhibition can only 
add to the prostration which is the threatened mode of 
death. But, according to M. Grisolle's mode of reason- 
ing, this result goes, he says, to show the ineJ0&cacy of 
bleeding much more than of tartar emetic, the former 
having been employed extensively at an early period 
(the fourth day on an average), and yet it had failed in 
arresting the progress of the disease. He ought rather 
to have come to the conclusion that there must have 
been some element in these cases which depletion could 



144 TREATMENT. 

not control, for all that bleeding can do is to remove 
plethora and diminish vascular tension, and these it liad 
accomplished as effectually here as in his cases of reco- 
very, when the use of tartar emetic was commenced. 
And as venesection and antimony combined had failed 
comparatively in these cases, while in another series 
the}^ had proved of such signal advantage, he might 
have come to a conclusion somewhat similar to that of 
Laennec in regard to catarrh, that there must probably 
have been some marked but unexplained difference be- 
tween the cases themselves. Nay, before coming to any 
conclusion as to the inutility of venesection, he should 
(in the progressive spirit of philosophical doubt, in spite 
of his own senses and the positive evidence furnished by 
physical signs) have been led to suspect that the series 
of cases in question might prove, when rigidly analyzed 
and accurately compared, to be made up of widely dis- 
tinct and separate affections. 

But suppose that to some of the fatal eighteen out of 
the thirty cases, in place of tartar emetic he had ex- 
hibited calomel and ipecacuanha — these agents would 
have produced the requisite degree of sedation, and, 
while they depressed, would have been far less likely 
than antimony to exhaust the nervous centres; and sup- 
pose that in others of these cases there may have been 
true rheumatism, which had extended from the bronchi to 
the parenchyma, and that the appropriate treatment for 
this disease by alkaline or other remedies, according to 
the indications pointed out at another place, had been 
instituted, might not the result have been very different? 
But in these cases, the exhausting effects of antimony 
were brought to bear on the nervous centres at the very 
time when, from large abstraction of blood, they were 
already greatly weakened. 

It may be useful here to inquire what are the effects 



TREATMENT. 145 

of tartar emetic, and the causes of what is understood 
by toJeration to its use. The phj^siological effects of 
antimony may be brought about alike either by intro- 
ducing it into the stomach, or by injecting it into a vein. 
Its action, therefore, is first on the nervous system : 
b}^ depressing its energies the force of the heart is also 
depressed, and less blood being sent to the nervous cen- 
tres, nausea and syncope occur very much as they do 
where the stimulus of blood is taken from the brain by 
venesection. Indirectly, through the nervous system, 
it exerts also a catalytic influence on the blood. De- 
pletion depresses nervous energy, and produces nausea, 
vomiting, and syncope, by lowering the action of the 
heart, and thus depriving the brain of its accustomed 
supply of blood. Antimony induces the same symptoms 
by its directly depressing action on the nervous system, 
and indirectly through its action on the heart, thereby 
withdrawing from the brain its normal stimulus. Hence 
it is that nausea, resulting from loss of blood, is gene- 
rally more transient than that which is produced by the 
action of antimony. And hence, also, it is that a pa- 
tient, however weak, will generally, after having fainted, 
rally from loss of blood. But where syncope results 
from the large or continued use of antimony (one of the 
modes of death in pneumonia), it is generally fatal, be- 
cause nervous energy, and with it vital irritability, has 
been worn out and exhausted by the previous use of the 
remedy. 

Direct sedation, depressed action of heart, and conse- 
quent cerebral depletion, indicated by nausea and vo- 
miting, are the leading physiological effects of anti- 
mony, which, being antagonized by certain pathological 
conditions, do not so readily occur (unless from the 
long-continued and exhausting effects of the medicine), 
and then the patient is said to tolerate the remedy. The 
10 



146 TREATMENT. 

states which antagonize and thereby prevent the direct 
effects of antimony, are an acute, articular, fibrous or 
serous inflammation, which, adding increased force to 
the heart's action, render it not less difficult, in some 
cases, to bleed an individual to syncope than to sicken 
him by nauseants, which act in. virtue of their depress- 
ing effects on the nervous system. The increased force 
with which, under these circumstances, the blood is sent 
to the brain, antagonizes directly the depressing effects 
of antimony. Thus, an acute iibro-bronchitis or pleuri- 
tis often gives to the action of the heart a force not 
easily counterbalanced by the sedative effects of tartar- 
ized antimony; and the brain continuing to receive its 
normal supply of blood, no nausea is produced. 

But the condition which antagonizes more perfectly 
the action of tartarized antimony, is engorgement of 
one or both lungs, whereby the return circulation from 
the head is obstructed, and the brain is kept supplied, 
as long as the engorgement lasts, with more than its 
normal share of the circulating current. The hebetude 
of mind, and congestion of the capillaries about the face, 
so frequently accompanying these cases, are proofs that 
such is reallj^ the state of the cerebral circulation, and 
it will generally be found that toleration to tartarized 
antimony is proportionate to the degree of pulmonary 
engorgement. 

It will now be seen that the absolute barriers to the 
emetic action of antimony are the contemporaneous 
occurrence of pulmonary engorgement and acute fibrous 
or serous inflammation; the one adding to the force of 
the heart, while the other at the same time interferes 
with the return of blood from the head. 

But while the more immediate effects of antimony 
are thus overcome by pathological conditions, there are 
others of its more remote effects which still go on; the 



TREATMENT. 147 

exlianstlon of the vital energies, the impoverishment of 
the hlooci, and often the induction of irremediable pros- 
tration. Mr. Headland* is of opinion that tartar-emetic 
exerts a special action on the.vagas nerve; but were 
such the case, it is not easy to see how its effects in this 
particular could be overcome, as just expLained, by cer- 
tain morbid conditions. 

Venesection depresses vitality by taking from the 
nervous centres their accustomed sujoport. Ipecacuanha 
depresses also by calming excitability of the nervous 
system; but antimony exhausts and finally extinguishes 
nervous energy. "When, in the course of acute disease, a 
patient dies from loss of blood, the muscular fibre will 
still respond to the stimulus of galvanism; but wdien, 
on the contrary, he dies from the combined effects of 
disease and antimony, vital irritability ceases at the 
moment of death. 

A knowledge of fibrous bronchitis explains to us how 
it w^as that the humoral w^riters observed a fancied 
resemblance between catarrh and rheumatism, and why 
it was that Sarcone and Morgagni derived advantage 
from the use of bicarbonate of potash and other alkaline 
remedies which they recommend both in bronchitis and 
in inflammatory infarctus of the lung. They adminis- 
tered these remedies with the idea that they diminished 
the viscosity of the humors, and thereby produced a 
more abundant evacuation of fluids from the lungs. 
Mascagni revived this treatment towards the close of the 
last century. He entertained the more philosophical 
idea, that they were useful in all stages of pneumonia, 
because of their action on the kidneys, skin, and intes- 
tines, thereby rendering the expectoration from the 
bronchi less viscid and more copious and fluid. Now, 

* Essay on the Action of Medicines, p. 310. 



148 TREATMENT. 

were all pneumonias rheumatic in their character, and 
were the rheumatism giving rise to them invariably pro- 
duced by uric acid and its compounds, there is hardly a 
doubt that experience would have established the alka- 
line treatment for pneumonia, and that, instead of being 
abandoned, it would have become universal. But we 
have shown, that rheumatism of the lungs, as well as of 
other fibrous structures, often depends on the presence 
of earthy phosphate, where acetic acid is the best reme- 
dy, and where alkalies, instead of improving, would, on 
the contrary, only aggravate the disease. 

The pneumonias which so frequently terminate cases 
of Bright's disease, often furnish striking examples of the 
rheumatic variety of this affection. The reader is aware 
that, under these circumstances, engorgement of the 
lungs rarely sets in until, from long-continued albumi- 
nuria, suppression of urine, and the supervention of 
dropsy, it is evident that the blood has lost its plasticity, 
and that vascular lesions and congestions, superadded to 
the granular disease, have entirely obstructed the func- 
tions of the kidneys. Under these circumstances, all the 
effete materials which it is the province of the kidneys 
to secrete are retained, giving rise to bronchitis, on which 
generally engorgement of the parenchyma rapidly su- 
pervenes. 

That the experience of British practitioners has led 
them to prefer calomel and opium in the treatment of 
pneumonia, while the French entertain a partiality for 
antimony, may perhaps be explained by the fact that 
the climate of England being much more humid than 
that of France, the probability is that the rheumatic 
variety of the disease is much more frequent on the 
north than it is on the south side of the Channel, and, 
accordingl}', that in the comparatively dry and sunny 
climate of France the congestive form of the disease may 



TREATMENT. 149 

be the most frequent. For that calomel and opium is a 
much better general treatment for rheumatic bronchitis 
and pneumonia than antimony is, there can be little 
doubt; and just as little doubt, on the other hand, that 
antimony is far better suited as an exclusive treatment 
than calomel and opium are for the congestive and sim- 
ple inflammatory varieties of pneumonia. 

In examining healthy individuals for life assurance, 
the writer has frequently observed murmurs about the 
hearts of many, particularly with the second sound, who 
had never in their lives suffered with general rheuma- 
tism; and where these were asked whether they had 
ever been troubled with a worrying, long continued dry 
cough, they generally answered in the affirmative. 

It is not insisted that the division or classification of 
the different varieties of rheumatism a^ccording to the 
states of the fluids, uric acid, phosphatic, soda-uric, and 
that form depending on the presence of insoluble ex- 
tractive matters, is the best arrangement. It is only 
contended that it has been found useful as a therapeutical 
guide. 

Neither is it insisted that the treatment adopted for 
the relief of rheumatic bronchitis is the best; on the 
contrary, it is believed that as this disease, whether 
simple or complicated, comes to be better understood, its 
treatment, in the hands of good observers, will be ren- 
dered more certain and successful. It is believed, also, 
that the special and differential symptomatology of this 
affection will become far more complete. 

The writer is prepared only to contend for the etiology 
and pathological semeiology of this disease, and the 
absolute importance of making it an independent and 
distinct entity. The position assumed can be doubted 
by no one who believes that certainty in medicine is 
based solely on accurate diagnosis. 



150 TREATMENT. 

The therapeutic portion of this essay proposes no new 
remedies, but, while it advises the application of particu- 
lar known agents to special pathological states, it, at the 
same time, advocates the abandonment of other esta- 
blished modes of treatment, as not only useless, but 
often, under given conditions, highly prejudicial. 



CATALOGUE 

OF 

BLANCHAED & LEA^S 
MEDICAL AXD SURGICAL PUBLICATIONS. 

PHILADELPHIA, DECEMBER, 1853. 



TO THE MEDICAL PROFESSION. 

In pubmittiag the following catalogue of our publications in medicine and 
the collateral sciences, we beg to remark, that no exertions are spared to render the 
issues of our press worthy a continuance of the confidence which they have thus far 
enjoyed, both as regards the high character of the works themselves, and in respect 
to every point of typographical accuracy and mechanical execution. Grentlemeu 
desirous of adding to their libraries from our list, can in almost all cases procure the 
works they wish from the nearest bookseller, who can readily order any which he 
may not have on hand. From the great variation in the expenses of transportation 
through territories so extensive as those of the United States, prices cannot be the 
same in all sections of the country, and therefore we are unable to affix retail prices 
to our publications. Information on this point may be had of booksellers generally, 
or from ourselves, and all inquiries respecting any of our books will meet with 
prompt attention by addressing 



December, 1853. 



BLAXCHARD & LEA, Philadelphia. 



Tm MEDICAL PEEIOraCALS, FREE OF POSTAGE, 

FOR FIVE ©OI.I.AHS FEK Al^i^UH. 



THE AMERICAN JOURXAL OF THE MEDICAL SCIENCES, subject to 

postage, when not paid for in advance, $5 00 

THE MEDICAL NEWS AND LIBRARY, invariably in advance, - - I 00 
or, BOTH PERIODICALS furnishcd, tree of postage, for Five Dollars remitted 
in advance. 



THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES, 
Edited by ISAAC HAYS, M. D., 

i? publi>hed Quarterly, on the first of January, Apri], July, and October. Each number contains 
at least two hundred and eighty large octavo pages, appropriately illustrated, wherever necessary, 
by engravings on copper, stone, or wood. It has now been issued regularly for a period of thirty- 
five years, during a quarter of a century of which it has been under the control of the present 
editor. Throughout this long space of time, it has maintained its position in the highest rank of 
medical periodicals both at home and abroad, and has received the cordial support of the entire pro- 
t'ession in this country. Its list of Collaborators will be found to contain a large number of the 
most distingui>hed names of the profession in every section of the United States, rendering the de- 
partment devoted to 

ORIGINAL COMMUNICATIONS 

full of varied and important matter, of great interest to ail practitioners. 

As the aim of the Journal, however, is to combine the advantages presented by all the different 
varieties of periodicals, in its 

REVIEW DEPARTMENT 

will be found extended and impartial reviews of all important new works, presenting subjects of 
novelty and interest, together with very numerous 

BIBLIOGRAPHICAL NOTICES, 

including nearly all the medical publications of the day, both in this country and Great Britain, with 
a choice selection of the more important continental wqrks. This is followed by tbe 



BLANCHARD & LEA'S MEDICAL 



QUARTERLY . SUMMARY, 

being a very full and complete abstracl, methodically arranged, of the 

IMPROVEiJlENTS AND DISCOVERIES IN THE MEDICAL SCIENCES. 

This department of the Journal, so important to the practising physician, is the object of especial 
care on the part of the editor. It is clas!<ified and arranged under diflerent heads, thus facilitating 
ihe researches of the reader in pursuit of particular subjects, and will be found to present a very 
Jull -dud accurate digest of all observations, discoveries, and inventions recorded in every branch of 
medical >cience. The very extensive arrangements of the publishers are >uch as to afford to the 
editor complete materials for this purpose, as he not only regularly receives 

ALL THE AMERICAN MEDICAL AND SCIENTIFIC PERIODICALS, 

but also twenty or thirty of the more important Jo-_;nals issued in Great Britain and on the Coiiti- 
nent, thus presenting m a convenient compass a thorough and complete abstract of everythmg 
inleresimgor important to the physician occurring in any part of the civilized world 

An evidence ot^ the success which has attended these efforts may be found in the constant and 
>teady increase in the sub.-cription li>t, which renders it advisable for gentlemen desiring the 
Journal, to make known their wishes at an early day, in order to secure a year's set with certainty, 
the publishers having frequently been unable to"supply copies when ordered late in the year. To 
their old subscribers, many of whom have been on iheir list for twenty or thirty years, the publish- 
ers feel that no promises are necessary; but those who may desire lor the first time to subscribe, 
can rest assured that no exertion will'be spared to maintain the Journal in the high position which 
it has occupied for so long a period. 

By reference Id file' (eftrts it will be seen that, in addition to this large amount of valuable and 
practical informatioti on every branch of medical science, tlie subscriber, by paying in advance, 
becomes entitled, without further charge, to 

THE MEDICAL NEWS AND LIBRARY, 

a monthly periodical of thirt^'-two large octavo pages. Its "News Department" presents the 
current information of the day, while tlie " Library DEPARTr-iENT" is devoted to presenting stand- 
ard works on various brandies of medicine. Within a few years, subscribers have thus received, 
without expense, the following works which have passed through its columns : — 

WATSON'S LECTURES ON THE PRACTICE OF PHYSIC. 

BRODIE'S CLINICAL LECTURES ON SURGERY. 

TODD AND BOWMAN'S PHYSIOLOGICAL ANATOMY AND PHYSIOLOGY OF MAN. 
Parts I., II., and III., with numerous wood-cuts. 

WEST'S LECTURES ON THE DISEASES OF INFANCY AND CHILDHOOD. 

MALGAIGNE'S OPERATIVE SURGERY, with wood-cuts, and 

SLMON'S LECTURES ON GENERAL PATHOLOGY. 

While the year 1853, presents 

THE CONTINUATION OF TODD & BOWMAN'S PHYSIOLOGY, 

BEAUTIFULLY ILLUSTRATED ON WOOD. 

ii^^ Subscribers for 1853, who do not possess the commencement of Todd and Bowman can 
obtain it, in a handsome octavo volume, of 552 pages, with over 150 illustrations, by mail, fvee of 
postage, on a remittance of $2 50 to the publishers. 



It will thus be seen that for the small sum of FIVE DOLLARS, paid in advance, the subscriber 
will obtain a Quarterly and a Monthly periodical, 

EMBRACING ABOUT FIFTEEN HUNDRED LARGE OCTAVO PAGES 

mailed to any part of the United States, free of postage. 

These very favorable terms are now pre^ented by llae publishers with the view of removing all 
difficulties aiid objections to a full and extended circulation of the Medical Journal to the office of 
every member of the profession throughout the United Slates. The rapid extension of mail facili- 
ties, will now place the numbers before sub-eribers with a certainty and dispaleh not heretofore 
attainable; while by the system now proposed, every subscriber throughout the Union is placed 
upon an equal footing, at the very reasonable price of Five Dollars for two periodicals, without 
further expense. 

Those subscribers who do not pay in advance will bear in mind that their subscription of Five 
Dollars will entitle them to the Journal only, without the News, and that they will be at the expen.-e 
of their own postage on the receipt of each number. The advantage of a remittance when order- 
ing the Journal will thus be apparent. 

As the Medical News and Library is in no case sent without advance payment, its subscribers 
will always receive it free of postage. 

It should also be borne in mind that the publishers will now take the risk of remittances by mail, 
only requiring, in cases of loss, a certificate from the subscriber's Postmaster, that the money was 
duly mailed and forwarded 

' ^^ Funds at par at the subscriber's place of residence received in payment of subscriptions. 

Address, BLANCHARD & LEA, Philadelphia. 



AND SCIENTIFIC PUBLICATIONS. 



3 



ASHWELL (SAMUEL), M.D. 
A PRACTICAL TREATISE ON THE DISEASES PECULIAR TO WOMEN. 

Illustrated by Cases derived from Hospital and Private Practice. With Additions by Paul Beck 

111 one octavo volume, ol'520 pages. 



GoDDARD, M. D. Second American edition. 



One of the very best works ever issued from the 
press on the diseases of females. — Western Lancet. 



This is an invalual)le work.- 
auJ Surgical Journal. 



-Missouri Medical 



We strongly recommend Dr. Ashweli's Treatise 
to our readers as n valuable book- of reference, on an 
extensive, complicated, and liij-lily imi)ortant class 
of diseases. — Edinburgh Monihlij Journal of Med. 
Sciences. 



ARNOTT (NEILL), M. D. 
ELEMENTS OF PHYSICS; or Natural Philosophy, General and Medical. 

Written for universal use, in plain or non-technical lanti^uag-e. A new edition, by Isaac Hays, 
M. D. Complete in one octavo volume, ot"4S4 pages, with about two hundred illustrations. 



ABERCROMBIE (JOHN), M. D. 
PATHOLOGICAL AND PRACTICAL RESEARCHES ON DISEASES OF 



THE STOMACH, INTESTINAL CANAL, cV'c. 
ot"260 pages. 



Fourth edition, in one small octavo volume. 



BENNETT (HENRY), M. D. 
A PRACTICAL TREATISE ON INFLAMMATION OF THE UTERUS, 

ITS CERVIX AND APPENDAGES, and on its connection with Uterine Di.-^ease. Fourlh 
American, liom the third and revised London edition. In one neat octavo volume, o.f 430 pages, 
with wood-cuts. {Now Ready.) 

This edition will be found materially improved over its predecessors, the author having- carefully 
re vised it, and made considerable additions, amounting to between seventy-five and one hundred 
pases. 



We shall not call it a second edition, because, as 
Dr. Bennett truly observes, it is really a new work. 
Jt will be found to contain not only a faithful histo- 
ry of the various pathological changes produced by 
inflammation in the uterus and its annexed organs, 
in the different phases of female life, but also an ac- 
curate analysis of the influence exercised by inflam- 
mation in the production of the various morbid con- 
ditions of the uterine system, hitherto described and 
treated as functional. — Britiskand Foreign Medico- 
Chirurgical Review, 

Few works issue from the medical press Avhich 
are at once original and sound in doctrine ; but such, 
we feel assured, is the admirable treatise now before 



us. The important practical precepts which the 
author inculcates are all rigidly deduced from facts. 
. . . Every page of the book is good, and eminent! y 
practical. ... So far as we know and believe, it is 
the best work on the subject of which it treats. — 
Monthly Journal of Medical Science. 

We refer out readers with satisfaction to this work 
for information on a hitherto most obscure and diffi- 
cult class of diseases. — London Medical Gazette. 

One of the best practical monographs amongst 
modern English medical books. — Transylvania Med. 
Journal. 



BEALE (LIONEL JOHN), M . R. 0. S., &c. 
THE LAWS OF HEALTH IN RELATION TO MIND AND EODY. 

A Series of Letters from an old Practitioner to a Patient. In one handsome volume, royal 12mo,, 
extra cloth. 



BILLING (ARCHIBALD), M. D. 
THE PRINCIPLES OF MEDICINE. Second American, from the Fifth and 

Improved London edition. In one handsome octavo volume, extra cloth, 250 pages. 



BLAKISTON (PEYTON), M. D., F. R. S., &c. 
PRACTICAL OBSERVATIONS ON CERTAIN DISEASES 

CHEST, and on the Principles of Auscultation. In one volume.. 8ro., pp. 384. 



OF THE 



BENEDICT (N. D.>, M. D. 
COMPENDIUM OF LECTURES ON THE THEORY AND PRACTICE 

OF MEDICINE, delivered by Professor Chap.^ian in the University of Pennsylvania. In one 
octavo volume, of 2.58 pages. 



BURROWS (GEORGE), M. D. 

ON DISORDERS OF THE CEREBRAL CIRCULATION, and on the Con- 
nection between the Affections of the Brain and Diseases of the Heart. In one 8vo. vol., -wilii 
colored plates, pp. 21t3. 



BLANCHARD & LEA'S MEDICAL 



BUDD (GEORGE), M. D., F. R. S., 

Professor of Medicine, in King's College, London. 

ON DISEASES OF THE LIVER. Second American, from the second and 

enlarged London edition. In one very handsome octavo volun^e, with four beautifully colored 
plates, and numerous wood-cuts. pp. 4G8. New edition. {Juat Issued.) 

The reputation which this work has obtained as a full and practical treatise on an important class 
of diseases will not be dinninished by this improved and enlarg-ed edition. It has been carefully and 
thoroughly revised by the author; the nniriher of plates has been increased, and the style of its me- 
chanical execution will be found materially improved. 



^The full digest we have given of the new matter 
introduced into the present volume, is evidence of 
the value we place on it. The tact that the profes- 
jfion has required a second edition of a monograph 
such as that before us, bears honorable testimony 
to its usefulness. For many years, Dr. liudd's 
work must be the authority of the i;reat mass of 
British practitioners on the hepatic di.'seases ; and it 
is satisfactory that the subject has been taken up by 
so able and experii^nccd a physician — British and 
Foreign Medico-C hir urgical Revieiv. 



We feel bound to say that Dr. Budd*8 treatise is 
greatly in advance of its predecessors. It is the first 
work in wliich the results of microscopical anatomy 
and the discoveries of modern cheinJKlry have been 
brought fully to bear upon the pathology and treat- 
ment of diseases of the liver ; and it is the only work 
in which a metliod of studying diseases of tliis organ, 
founded upon stricily inductive principlus, is de- 
veloped.— i^M/;/in Medical Press. 



BUCKLER (T. H.), M. D., 

Formerly Physician to the Baltimore Almshouse Infirmary, &c. 

ON THE ETIOLOGY, PATHOLOGY, AND TREATMENT OF FIBRO- 

BRONCHITIS AND FtHEUMATIC PNELTMONIA. In one handsome octavo volume, extra 
cloth, {jyfow Keady.) 



BLOOD AND URINE (MANUALS ON). 
BY JOHN WILLIAM GRIFFITH, G. OWEN REESE, AND ALFRED 

MARKWICK. One thick volume, royal 12mo., extra clolh, with plates, pp. 460. 



BRIGHAM (AMARIAH), M.D. 
ON MENTAL CULTIVATION AND EXCITEMENT. In one neat volume, 

18mo., extra cloth. 



BRODIE (SIR BENJAMIN O, M. D., &c. 
CLINICAL LECTURES ON SURGERY. ' 1 vol. 8vo., cloth. 850 pp. 

BY THE SAME ArTHOR. 

PATHOLOGICAL AND SURGICAL OBSERVATIONS ON THE DIS- 
EASES OF THE JOINTS. 1 vol. 8vo., cloth, pp. 216. 

BY THE SAME AUTHOR. 

LECTURES ON THE DISEASES OF THE URINARY ORGANS. 1 vol. 

8vo., cloth, pp. 214. 

*^^ These three work? may be had neatlv bound together, forming- a large volume of" Brodie's 
Surgical Works." pp. 780. 



BIRD (GOLDING), A. M., M. D., &c. 
URINARY DEPOSITS: THEIR DIAGNOSIS, PATHOLOGY, AND 

THERAPEUTICAL INDICATIONS. A new American, from the third and improved Loudon 

edition. With over sixty illustrations. In one royal 12nio. volume, extra cloth, pp. 338. 

The new edition of Dr. Bird's work, though not ) nary secretion, which have contributed so much to 
icicveased in size, has been greatly modified, cuid j the increase of our di.-ignostic powers, and lo the 
much of it rewritten. It now presents, in a com- i extensidn and satisfactory employment of our thera.- 
pendious form, the gist of all that is known and re- ! pentic resources. In the preparation of this new 
liable in this department. From its terse style and ' edition of his work, it is obvious that Dr. Golding 
convenient size, it is particularly applicable to the Bird has spared no pains to render it a faithful rejiie- 
student, to whom we cordially commend it. — The ; sentation of the present state of scientific knowledge 
Medical Examiner. i on the subject it embraces. 

It can scarcely be necessary for ns to savanything Although, ot'course, there are many topics which 
of the merits of this well-known Treatise', winch so are open to ditierences of opinion, we cannot point 
admirably brings into practical application the re- \ *<• any well-substantiated result of inquiry whicn 



suits of those microscopical and chemical researches 
regarding the physiology and pathologj' of the uri- i 



the author has overlooked.— r/ie£rU/s/ia«dFort;« 
Medico-C hirurgical Review. 



BY THE SAME AL'THOR. 

ELEMENTS OF NATURAL PHILOSOPHY; being an Experimental Intro- 
duction to the Physical Sciences. Illustrated with nearly four hundred wood-cuts. From the 
third Londoa edition. In one neat volume, royal 12mo. pp. 402. 



AND SCIENTIFIC PUBLICATIONS, 



BARTLETT (ELISHA), M. D., 

Professor of Materia Medica and Medical Jurisprudence in the College of Physicians and 
Surgeons, New York. 

THE HTSTOllY, DIAGNOSIS, AND TREATMENT OF THE FEVERS 

OF THE UNITED STATES. Third edition, revised and improved. In one octavo volume, 

of six hundred pages, beautifully printed, and strongly bound. 

In preparing a new edition of this standard work, the author has availed himself of such obser- 
vations and investigations as have appeared since the publication of his last revision, and he has 
endeavored in every way to render it worthy of a continuance of the very marked favor with which 
it has been hitherto received. 



The masterly ^nd elegant treatise, by Dr. Bartlett 
is invaluable to the Ainerican student and practi- 
tioner. — Dr. Holmes's Report to the Kat, Med. Asso- 
ciation. 

We regard it, from the examination we have made 
of it, the" best work on fevers extant in our language, 
and as such cordially recommend it to the rnedioal 
public. — St. Louis Medical and Surgical Journal. 

Take it altogether. -it is the most complete history 
of our fevers which has yet been published, and 
every practitioner should avail himself of its con- 
teats. — The Western Lancet. 



Of the value and importance of such a work, it is 
needless here to speak ; tlie profession of tlie United 
States owe much to the author for the very able 
volume which he has presented to them, and for the 
careful and judicious manner in which he has exe- 
cuted his task. No one volume with which we are 
acquainted contains so complete a history of our 
fevers as this. To Dr. Bartlett we owe our best 
thnnks for the very able volume he has given us, as 
embodying certainly the most complete, methodical, 
and satisfactory account of our fevers anywhei-e lo 
be met with.— The Charleston Med. Journal and 
Review. 



BY THE SAME AUTHOR. 

AN INQUIRY INTO THE DEGREE OF CERTAINTY IN MEDICINE, 

and into the Nature and Extent of its Power over Disease. In one volume, royal ISmo. pp. 84. 



BOWMAN (JOHN E.), M.D. 
PRACTICAL HANDBOOK OF MEDICAL CHEMISTRY. In one neat 

volume, royal 12mo., with numerous illustrations, pp. 2S8. 

BY THE SAME AUTHOR. 

INTRODUCTION TO PRACTICAL CHEMISTRY, INCLUDING ANA- 

LYSIS. WitU numerous illustrations. In one neat volu.me, royal 12mo. pp. 350. 



BARLOW (GEORGE HJ, M. D. 
A MANUAL OF THE PRINCIPLES AND PRACTICE OF MEDICINE. 

In one octavo volume. (Preparing.) 



COLOMBAT DE L'ISERE. 
A TREATISE ON THE DISEASES OF FEMALES, and on the Special 

Hygiene of their Sex. Translated, with many Notes and Additions, by C. D. Meigs, M. D. 

Second edition, revised and improved. In one large volume, octavo, with numerous wood-cuts. 

pp. 720. 

The treatise of M. Colombat is a learned and la- ' M. Colombat De L'Jsere has not consecrated ten 
borious commentary on these diseases, indicating years of studious toil and research to the frailer sex 
very considerable research, great accuracy of judg- in vain; and although we regret to hear it is at the 
ment, and no inconsiderable personal experience, expense of health, he has imposed a debt of gratitude 
"With the copious notes and additions of its experi- as well upon the profession, as upon the mothers and 
enced and very erudite translator and editor. Dr. daughters of beautiful France, which that gallant 
Meigs, it presents, probably, one of the most com- nation knows best how to acknowledge. — Neto Or- 
plete and comprehensive works on the subject we leans Medical Journal. 
possess. — American Med. Journal. \ 



M. D., F. R. S., &:c. 

OF THE CAUSES, NATURE, AND TREATMENT OF PALSY AND 

APOPLEXY, and of the Forms, Seats, Complications, and Morbid Relations of Paralytic and 
Apoplectic Disea:<es. In one volume, royal 12mo., extra cloth, pp. 326. 



CHAPMAN (PROFESSOR N.), M. D., &lc. 
LECTURES ON FEVERS, DROPSY, GOUT, RHEUMATISM, &c. &c. 

In one neat Svo. volume, pp. 450. 



CLYMER (MEREDITH), M. D., &,c. 
FEVERS; THEIR DIAGNOSIS, PATHOLOGY, AND TREATMENT. 

Prepared and Edited, with large Additions, from the Essays on Fever in Tweedie's Library of 
Practical Medicine, In one octavo volume, of 600 pages. 



CARSON (JOSEPH), M. D., 

Professor of Materia Medica and Pharmacy in the University of Pennsylvania. 

SYNOPSIS OF THE COURSE OF LECTURES ON MATERIA MEDICA 

AND PHARMACY, delivered in the University of Pennsylvania. In one very neat octavo 
volumej of 208 pages. 



BLANCHARD & LEA'S MEDICAL 



CARPENTER (WILLIAM B.), M. D., F. R. S., &,c., 

Examiner in Physiology and Comparative Anatomy in the University of London. 

PRINCIPLES OF HUMAN PHYSIOLOGY; with their chief applications to 

Psychology, Pathology, Therapeutics, Ilyg-iene, and Forensic Medicine. Fifth American, from 
the' fourth and enlarged London edition. With three hundred and fourteen illustrations. Edited, 
Willi additions, by Fiiancis Guuney Smith, M.D.. Professor of the Institutes of Medicine in the 
Pennsylvania Medical College, tVc. In one very large and beautiful octavo volume, of about 1100 
large pages, handsomely printed and strongly bound in leather, with raised bands, New edition. 
(Just Issued.) 

From, the Authofs Preface to the present Edition. 

'•When the author. t)n the completion of his ' Principles of General and Comparative Pliysiology,' 
applied himself to the preparation of his ' Principles of Human PJiysiology,' for the press," he found 
that nothing short oi cai. entire remodelling of the preceding edition would in any degree satisfy his 
notions of what such a treatise ought to be. For although no fundamental change had taken place 
during the interval in the fabric ot Physiological Science, yet a large number of less important 
modifications had been efTected, which had combined to produce a very considerable alteration in 
its aspect. Moreover, the progressive maturation of his own views, and hi.s. increased experience 
as a teacher, had not only rendered him more keenly alive to the imperiections which were inherent 
in its original plan, but had caused him to look upon many topics in a light A'ery different from that 
under which lie had previously regarded them ; and, in particular, he felt a strong desire to give to 
liis work as ^raf«zra7 a character as possible, without foregoing the position which (he trusts he 
may say without presumption) he had succeeded in gaining for it, as a philosophical ex'posUion oi 
one important department of Physiological Science. He was led, therefore, to the determination 
of. in reality, producing a new treatise., in which only those parts of the old should be retained, 
which might express the existing state of knowledge, and of his own opinions on the points to which 
they relate." 

The American edition has been printed from sheets prepared for the purpose by the author, who 
has introduced nearly one hundred illustrations not in the London edition ; while it has also enjoyed 
the advantage of a careful superintendence on the part of the editor, who has added notices of such 
more recent investigations as had escaped the author's attention. Neither care nor expense has 
l)een spared in the mechanical execution of the work to render it superior to former editions, and it 
IS confidently presented as in every way one of the handsomest volunjes as yet placed before the 
medical profession in this country. , 

The most complete work on the science in our . The best text-book in the language on this ex- 
langaage.— ^w. Med. Journal. \ tensive subject.— Lo7irfo;i Med. Times. 

The most complete exposition of physiology which j %'''^^^,f? ''^s'^'^''' ""^ *^'' '''^"'^' "^ ''''''''^* 
any language can at present give.— ^rir. and For. — ^^ • ^- ^^^^^- J-imes. 

Med.-Chirurg. Revietv. The standard of authority on physiological suh- 

jects. * * * In the present edition, to particularize 

We have thus adverted to some of the leading the alterations and additions which liave been made, 
"additions and alterations," which have l)een in- .would require a review of the whole work, since 
troduced by the author into this edition of his phy- scarcely a subject has not been revised and altered, 
siology. These will be found, however. A'ery far to i added to, or entirely remodelled to adapt it to the 
exceed the ordinary limits of a new edition, " the ; present state of the science. — Charleston Med. Journ. 
old materials having been incorporated with the Any reader who desires a treatise on physiology 
new, rather than the new with the old.' It now . fg^i hij^self entirely safe in ordering this.-- 

certainly presents the most complete treatise on the ^Yestern Med. and Surg. Jovrnal. 
r.Hbject withm the reach of the American reader ; I .u- x, . a- r , u • •. -n » 

and while, for availability as a text-book, we may | From this hasty and imperfect allusion it Avill be 
Berhansreo-ret its growth in bulk, we are sure that ' seen by our readers that the alterations and addi- 
The student of physiology will feel the impossibility ' tions to this edition render it almost a ^e^v work— 
of Dresentin<r a thorough digest of the facts of the ' and we can assure our readers that it is one of the 
Gcience within a more limited compass.— 3Iedical ' best summaries of the existing facts of physiological 
ir-rnmii^or ' scieucc withiu the reach of tlie English student and 

jLxami7itr. | phj-sician.— iV. Y. Jouriial of Medicine. 

The greatest, the most reliable, and the best hook j r^i^^ profession of this country, and perhaps also 
on the subject which we know ot in the i.nglisli ; of Europe, have anxiously and for some time awaited 
language. — Stethoscope. \ tl^g announcement of this new edition of Carpenter's 

The most com],]ete work now extant in our Ian- Human Physiology. His former editions have for 
tlua-e.-JV. O. Med. Register. \ "?'■»")' years been almost the only text-book on Phy- 

f' = ; siology in all our medical schools, and its circula- 

Tlie changes are too numerous to admit of an ex- j tion among the profession has been unsurpassed by 
tended notice in this place. At every point where ^ any work in any department of medical science, 
tiie recent diligent labors of organic chemists and | It is quite unnecessary for us to speak of this 
micrographers have furnished interesting and vain- | work as its merits -would justify. The mere an 
able facts, they have been appropriated, and nop.-ijns nouncement of its appearance will afTord thehighest 
have been spared, in so incorporating and arranging pleasure to every student of Physiology, while its 
them that the work may constitute one harmonious perusal Avill be of infinite service in advancing 
system. Southern Med. and burg. Journal. . physiological science. — Ohio Med. and Surg. Journ. 

BY THE SAME AUTHOR. 

PRINCIPLES OF GENERAL AND COMPARATIVE PHYSIOLOGY. 

Intended as an Introduction to the Study of Human Physiology; and as a Guide to the Philo- 
sophical pursuit of Natural History. New and improved edition, {pre2yari7}g.) 

BY THE SAME AUTHOR. {Preparing.) 

THE MICROSCOPE AND ITS REVELATIONS. In one handsome volume, 

beautifully illustrated with plates and wood-cuts. 



AND SCIENTIFIC PUBLICATIONS. 



CARPENTER (WILLIAM B.), M. D., F. R. S., 

Examiner in Physiology and Comparative Anatomy in the University of London. 

ELEMENTS (OR MANUAL) OF PHYSIOLOGY, INCLUDING PHYSIO- 

LOGICAL ANATOiNIY. Second American, from a new and revised London edition. With 
one hundred and ninety illustrations. In one very handsome octavo volume. {Lately Issued.) 

l\\ publishing the first edition of this work, its title was altered from that of the London volume, 
by the substitution of the word "Elements"' for that of " Manual," and with the author's sanctioa 
the title of "Elements" is still retained as being more expressive of the scope of the treatise. A 
comparison of the present edition with the former one will show a material improvement, the 
author having revised it thoroughly, with a view of rendering it completely on a level with the 
most advanced state of the science. By condensing the less important portions, these numerous 
additions have been introduced without 'materially increasing the bulk of the volume, and while 
numerous illustrations have been added, and the general execution of the work improved, it has 
been kept at its former very moderate price. 



To say that it is the best manual of Physiology 
now before the public, Avould not do sufficient justice 
to the author. — Buffalo Medical Journal. 

In his former works it would seem that he had 
exhausted the subject of Physiology. In the present, 
he gives the essence, as it were, of the whole. — N. Y, 
Journal of Medicine. 

Those who have occasion for an elementary trea- 
tise on Physiology, cannot do better than to possess 
themselves of the manual of Dr. Carpenter. — Medical 
Examiner. 



The best and most complete expose of modern 
Physiology, in one volume, extant in the Englisii 
language. — St. Louis Medical Journal. 

AVith such an aid in his hand, there is no excuse 
for the ignorance often displayed respecting the sub- 
jects of which it treats. From its unpretending di- 
mensions, it may not be so esteemed by those anxious 
to make a parade of their erudition; but \vhoever 
masters its contents will have reason to be proud of 
his physiological acquirements. The illustrations 
are well selected and finely executed.— Dwd^m Med. 
Press. 



BY THE SAME AUTHOR. 

A PRIZE ESSAY ON THE USE OF ALCOHOLIC LIQUORS IN HEALTH 

AND DISEASE, New edition, with a Preface by D. F. Condie, M. D., and explanations of 
scientific words. In one neat r2mo. volume. {Noio Ready.) 

This new edition has been prepared with a view to an extended circulation of this important little 
work, which is universally recognized as the best exponent of the laws of physiology and pathology 
applied to the subject of intoxicating liquors, in a form suited both for the profession and the public. 
To secure a wider dissemination of its doctrines the publishers have done up copies in flexible 
cloth, suitable for mailing, which will be forwarded through the post-office, free, on receipt of fifty 
cents. Societies and others supplied in quantities for distribution at a liberal deduction. 



CHELIUS (J. M.), M. D., 

Professor of Surgery in the University of Heidelberg, &c. 

A SYSTEM OF SURGERY. Translated from tlie German, and accompanied 
with additional Notes and References, by John F. South. Complete in three very large octavo 
volumes, of nearly 2200 pages, strongly bound, with raised bands and double titles. 



We do not hesitate to pronounce it the best and 
most comprehensive system of modern surgery with 
which we are acquainted. — Medico-C kirurgical Re- 
view. 

The fullest and ablest digest extant of all that re- 
lates to the present advanced state of surgical pa- 
thology. — American Medical Journal. 

As complete as any system of Surgery can well 
be. — Southern Medical and Surgical Journal. 



The most learned and complete systematic treatise 
noAV extant. — Edinburgh Medical Journal. 

A complete encycloposdia of surgical science — a 
very complete surgical library — by far the most 
complete and scientitic system of surgery in the 
English language. — iY. Y. Journal of Medicine. 

The most extensive and comprehensive account of 
the art and science of Surgery in our language.^- 
Lancet. 



CHRISTISON (ROBERT), M . D., V. P. R. S. E., &,c. 
A DISPENSATORY; or, Commentary on the Pharmacopoeias of Great Britain 

and the United States; comprising the Natural History, Description, Chemistry, Pharmacy, Ac- 
tions, U.«es, and Doses of the Articles of tiie Materia Medica. Second edition, revised and im- 
proved, with a Supplement containing the most important New Remedies. With copious Addi- 
tions, and two hundred and thirteen large wood-engravingfj. By R. Eglesfeld Griffith, M. D. 
In one very large and handsome octavo volume, of over 1000 pages. 



It is not needful that we should compare it with 
the other pharmacoposias extant, which enjoy and 
merit the confidence of the profession : it is enough 
to say that it appears to us as perfect as a Dispensa- 
tory, in the present state of pharmaceutical science, 
could be made. If it omits any details pertaining to 
this branch of knowledge which the student has a 



There is not in any language a more complete and 
perfect Treatise. — N. Y. Annalist. 

In conclusion, we need scarcely say that we 
strongly recommend this work to all classes of onr 
readers. Asa Dispensatory and commentary on the 
Pharmacopoeias, it is unrivalled in the English or 
any other language. — The Dublin Quarterly Journal . 



right to expect in such a work, we confess the omis- 
sion has escaped our scrutiny. AVe cordially recom- j We earnestly recommend Dr. Christison's Dis- 
mend this work to such of our readers as are in need I pensatory to all onr readers, as an indispensable 
of a Dispensatory. They cannot make choice of a companion, not in the Study only, but in the Surgery 
better.— Western Journ. of Medicine and Surgery. \ also. — British and Foreign Medical Review. 



BLANCHARD & LEA'S MEDICAL 



CONDIE (D. F.), M. D., 8cc. 
A PRACTICAL TREATISE ON THE DISEASES OF CHILDREN. Fourth 

edilion, revi-sed and augmented. In one large volume, 8vo., of nearly 750 pages. (iYow Ready.) 
From the Author's Preface. 

Tiie demand for another edition has afforded the author an opportunity of again subjecting the 
entire treatise to a careful revision, and of incorporating m it every important observation recorded 
^ince the appearance of the last edition, in reference to the pathology and therapeutics of the several 
diseases oi which it treats. 

In the preparation of the present edition, as in tiiosc which have preceded, while the author has 
appropriated to his use every important fact that he has found recorded in the works of others, 
having a direct bearing upon eitiier of the subjects of which he treats, and the numerous valuable 
observations — pathological as well as practical — dispersed throughout the pages of the medical 
journals of Europe and America, ho has, nevertheless, relied chieliy upon his own observations and 
experience, acquired during a long and somewhat extensive practice, and under circumstances pe- 
culiarl}- well adapted for the clinical study of the diseases of early life. 

Every species of hypothetical reasoning has, as much as possible, been avoided. The auliior Jias 
endeavored throughout the work to confine himself to a simple statement of well-ascertained patho- 
logical facts, and plain therapeutical directions — his cluef desire bfiiig to render it what its title 
imports it to be, a PRACXiCAr. treatise 0-\ the diseases of childrex. 

Dr. Condie's scholarship, acnmen, industry, and We feel assured from actual experience that no 
practical sense are manifested in this, as in all his [ physician's library can he complete without a copy 
numerous contributions to science. — Dr. Hohnes's ; of this worli. — i\\ Y. Jotcrnal of Medicine. 
Report to the American Medical Association. \ . , , ,. . , ,• , , 

„ , , , • ■ , , T^ ^ 1- , t A veritable pEcdiatnc encvclopsedia, and an honor 

Taken as a whole, in our judgment Dr. Condie s to American medical literature . -0 A io Medical and 
Treatise is the one from the perusal of winch the {Surgical Journal. 
practitioner in this country will rise with the great- \ 

est satisfaction — Western Journal of Medicine and We feel persuaded that the American medical pro- 
Svrgery. \ fession will soon regard it not only as a very good, 

One of the best works upon the Diseases of Chil- i?'^^ ^s the very best "Practical Treatise'on the 
dren in the English language.-ire^Zem Lancet. j Diseases oi Chi\d^^n.''-A'meruan MedicalJournal. 

Perhaps the most fall and complete work now be- I "We pronounced the first edition to be the best 
fore the profession of tlie United States; indeed, we work on the diseases of children in the English 
may sa}- in the English language. It is vastly supe- language, and, notwithstanding all that has been 
rior to most of its predecessors. —rran52/Zj;aniai\Ie(i. published, we still regard it iu that light. — Medical 
Journal. i Examiner. 



COOPER (BRANSBY B.), F. R. S., 

Senior Surgeon to Guy's Hospital, &c. 

LECTURES ON THE PRINCIPLES AND PRACTICE OF SURGERY. 

In one very large octavo volume, of 750 pages. (Lately Issued). 

For twenty-five years Mr. Bransby Cooper has I Cooper's Lectures as a most valuable addition to 
been surgeon to Guy's Hospital; and the volume | our surgical literature, and one which cannot fail 
before us may be said to consist of an account, of I to be of service both to students and to those who 
the results of his surgical experience during that | are actively engaged in the practice of their pi-ofes- 
long period. We cordially recommend Mr. Bransby I sion. — The Lancet. 



COOPER (SIR ASTLEY P.), F. R. S., &.c. 
A TREATISE ON DISLOCATIONS AND FRACTURES OF THE JOINTS. 

Edited by Bra>sby B. Cooper, F. R. S , &rc. With additional Observations by Prof J. C. 
Warren. A new American edition. In one handsome octavo volume, with numerous illustra- 
tions on wood. 

BY the same author. 

ON THE ANATOMY AND TREATMENT OF ABDOMINAL HERNIA. 

One large volume, imperial 8vo.. with over 130 lithographic figures. 

BY the same at;thor. 

ON THE STRUCTURE AND DISEASES OF THE TESTIS, AND ON 

THE THYMUS GLAND. One vol. imperial Svo.. with 177 figures, on 29 plates. 

BY the same AL'THOR. 

ON THE ANATOMY AND DISEASES OF THE BREAST, with twenty^ 

iive Miscellaneous and Surgical Papers. One large volume, imperial 8vo., with 252 [iguTG>, on 
36 plates. 

These last three volumes complete the surgical writings of Sir Astley Cooper. They are very 
handsomely printed, with a large number ot luhographic plates, executed in the best style, and are 
presented at exceedingly low prices. 



AND SCIENTIFIC TU BLI C A TIONS. 



CHURCHILL (FLEETWOOD), M . D., M. R. I. A. 
ON THE THEORY AXD PRACTICE OF MIDWIFERY. A new American, 

from the la<t and improved Endish edition. Edited, with Notes and Additions, by D. Francis 
CoNDiE, JVl. D., author of a '-Practical Treatise on the Diseases of Children," &c. With 139 
illustrations. In one very handsome octavo volume, pp. 510. {Lately Issued.) 

No work holds a higlier position, or is more de- 
serving of being placed in the hnnds of the tyro, 
the advanced student, or the practitioner. — Medical 
Examiner . 



To bestow pfaise on a hook that has received such | 
marked approbation would he superfluous. We need ; 
only say, tliercfore, th.-it if the first edition wns ! 
thought worthy of a favorable reception by tiie 
medical public, we can confidently alfurn tliat this 
■will he found much more so. Tiie lecturer, tlie 
practitioner, and the student, may all have recourse 
to its pages, and derive from tiieir perusal much in- ' 
terest and instruction in everything relatinsr to then- I 
retieal and practical midwitery. — Dublin Quarterly , 
Journal of Medical Science. \ 

A work of verj- great merit, and such as we can j 
ctiiifidenrly recommend to the study of every obste- | 
trie practitioner. — London Medical Gazette. i 

This is certainly the most perfect system extant. | 
It is the best adapted for the purposes of a text- j 
book, and that which he \vliose necessities confine 
him to one book, should select in preference to all 
others. — Southern Medical and Surgical Journal. 

The most jiopular %vork on midwifery ever issued 
from the American press. — Charleston Med. Journal. 

\Vere we reduced to the necessity of having hut 
one work on midwifery, and permitted to choose, 
we would unhesitatingly take Churchill. — Western 
Med. and Surg. Journal. 

It is impossible to conceive a more useful and 
elegant manual than Dr. Churchill's Practice of 
Midwifery. — Provincial 2Iedical Journal. 



I 



Certainly, in our opinion, the very best work on 
the subject which exists. — N. Y. Annalist. 



Previous editions, under the editorial supervision 
of Prof R. M. Hustcm, have been received with 
marked favor, and tliey deserved it; but this, re- 
printed I'rnm a very late Dublin edition, carefully 
revised and brought up by the autlior to the present 
time, does present an unusually accurate and able 
exposition of every important particular embraced 
in the department of midwitery. * * The clearness, 
directness, and precision of its teachings, together 
with the great amount oi statistical research which 
its text exhibits, have served to place it already in 
the foremost rank of works in this department of re- 
medial science. — N. O. Med. and Surg. Journal. 

In our opinion, it forms one of the best if not the 
very best text-book and epitome of obstetric science 
\vhich we at present possess in the English lan- 
guage. — Monthly Journal 0/ Medical Science. 

The clearness and precision of style in which it is 
written, and the greatamount of statistictil research 
\vhich it ccmtains, have served to place it in the first 
rank of works in this department of medical science. 
— N, Y. Journal of Medicine. 

Few treatises will be found better adapted as a 
text-book for the student, or as a manual for the 
frequent consukatiou of the young practitioner. — 
American Medical Jcurnal. 



BY THE SAME AUTHOR. 



0^ THE DISEASES OF INFANTS AND CHILDREN. 

handsome volume of over 600 pages. 



In 



large 



and 



We regard this volume as possessing more cloim.s ' 
to completeness than anj- other of the kind with | 
which we are acquamted. Most cordially and earn- i 
estly, therefore, do we commend it to our profession- | 
al brethren, and we feel assured that the stamp of 
their approbation will in due time be impressed upon 
it. After an attentive perusal of its contents, v/e 
hesitate not to say, that it is one of the most com- ! 
prehensive ever written upon the diseases of chil- i 
dren, and that, for copiousness of reference, extent of 1 
research, and perspicuity of detail, it is scarcely to 
be equalled, and not to be excelled, in any Ian- : 
guage. — Dublin Quarterly Journal. i 

After this meagre, and we know, very imperfect 1 
notice of Dr. Churchill's work, Ave shall conclude i 
by saying, that it is one that cannot fail from its co- ! 
piousness, extensive research, and general accuracy, | 
to exalt still higher the reputation of the author in j 
this country. The American reader \vill be particu- 
larly pleased to find that Dr. Churchill has done full 
justice thrimghout his work to the various American j 
authors on this subject. The names of Dewees, j 
Eberle, Condie, and Stewart, occur on nearly every \ 
page, and these authors are constantly referred to by i 
the author in terms of the highest praise, and with j 
the most liberal courtesy. — The Medical Examiner . ; 



The present volume Avill sustain the reputation 
acquired by the author from Ills previous v,''orks. 
The reader w'lW find in it full and judicious direc- 
tions for the management of infants at birth, and a 
compendious, but clear acc<mnt of the diseases to 
which children are liable, and the most successful 
mode of treating them. We must not close this no- 
tice without calling attention to the author's style, 
which is perspicuous and polished to a degree, we 
regret to say, not generally characteristic of medical 
works, ^ye recommend the ^vork of Dr. Churchill 
most cordially, both to students and practitioners, 
as a valuable and relial)le guide in the treatment of 
the diseases of children. — Am. Journ. of the Med. 
Sciences. 

We knoAV of no work on this department of Prac- 
tical Medicine which presents so candid and unpre- 
judiced a statement or posting up of our actual 
knowledge as this. — A', i'. Journal of Medicine. 

Its claims to merit both as a scientific and practi- 
cal -woi-k, are of the highest order. Whilst we 
would not elevj'.te it above every other treatise on 
the same subject, we certainly believe that very feAV 
are equal to it, and none superior. — Southern Med. 
and Surgical Journal. 



BY THE SAJIE AUTHOR. 



ESSAYS ON THE PUERPERAL FEVER, AND OTHER DISEASES PE- 

CULIAR TO WOMEN. Selected from the writings of British Authors previous to the close of 
the Eighteenth Century. In one neat octavo volume, of about four hundred and fifty pages. 

To these papers Dr. Churchill has appended notes, [ demies of that disease. The whole forms a very 
embodying whatever information has been laid be- | valuablecollectionof papers, by professional writers 
fore the profession since their authors' time. He has j of eminence, on some of the most importantaecidents 
also prefixed to the Essays on Puerperal Fever, I to which the puerperal female is liable. — American 
"vvhich occupy the larger portion of the volume, an Journal of Medical Sciences. 
interesting historical sketch of the principal epi- 



10 



BLANCHARD & LEA'S MEDICAL 



CHURCHILL (FLEETWOOD), M. D., M. R. 



&.C, 



ON THE DISEASES OF WOMEN; including those of Pregnancy and Child- 

bed. A new American edition, revised by ihe Author. Willi Notes and Addition?, by D Fran- 
cis CoNDiE, M. D., author of "A Practical Treatise on the Diseases of Children." In one large 
and handsome octavo volume, w^ith wood-cuts, pp. G84. {Just Issued.) 

From the Author'' s Preface. 
In reviewing this edition, at the request of my American publishers, I have inserted several new 
sections and chapters, and I have added, I believe, all the information we have derived from recent 
researches; in addition to which the publih.hers have been fortunate enough to secure the services 
of an able and highly esteemed editor in Dr. Condie. 

larity. This fifth eclitidn, before us. is well calcu- 
lated to mnintain Dr. Cliuichili's high reputation. 
It was revLsed and enlarged by the autlior, for his 
American pu!)lishers, and it seems to us that tliereis 
scarcely any species of desirable information on its 
subjects tliat may not be f »und in this work. — The 
Western Joitrnal of Medicine and Surgery. 



AVe now regretfully take leave of Dr. Churchill's 
book. Had our typographical limits permitted, we 
should gladly have l>orrowed more from its richly 
stored pages. In conclusion, wc heartily recom- 
mend it to the profession, and would at the same 
time express our firm conviction that it will not only 
add to the reputation of its author, hut will prove a 
work of great and extensive utility to obstetric 
practitioners. — Dublin Medical Press. 

Former editions of this work have been noticed in 
previous numbers of the Journal. The sentiments of 
high commendati(m expressed in those notices, have 
only to be repeated in this; not from the fact tliat 
the" profession at large are not aAvare of the high 
merits which this Avork really possesses, but from a 
desire to see the principles and doctrines therein 
contained more generally recognized, and more uni- 
versally earned out in practice. — N. Y. Journal of 
Medicine. 

We know of no author who deserves that appro- 
bation, on "the diseases of females," to the same 
extent that Dr. Churchill does. His, indeed, is the 
only thorough treatise Ave know of on the subject ; 
and it may be commended to practitioners and stu- 
dents as a masterpiece in its particular department. 
The former editions of this work have been com- 
mended strongly in this journal, and they have won 
their way to an extended, and a well-deserved popu- 



AVe are gratified to announce a new and revised 

edition of Dr. Churchill's valuable work on the dis- 
eases of females We have ever regarded it as one 
of the very best works on the subjects embraced 
within its scope, in the English language; and the 
present edition, enlarged and rcAMsed by the author, 
renders it still more entitled to the confidence of the 
profession. The valuable notes of Prof Huston 
have been retained, and contribute, in no small de- 
gree, to enhance the value of the work. It is a 
source of congratulation that the publishers have 
permitted the author to be. in this instance, his 
own editor, thus securing all the revision ■which 
an author alone is capable of making. — The Western 
Lancet. 

Asa comprehensive manual for students, or a 
Avork of reference for practitioners, we only speak 
with common justice when we say that it surpasses 
any other that has ever issued on the same sub- 
ject from the British press. — The Dublin Quarterly 
Journal. 



DEWEES (W. P.), M.D., &c. 
A COMPREHENSIVE SYSTEM OF MIDWIFERY. Illustrated bj occa- 

sional Cases and many Engravings. Twelfth edition, with the Aulbor's last Improvements and 
Corrections. In one octavo volume, of 600 pages. {Just Issued.) 

BY THE SAME AL'THOR. 

A TREATISE ON THE PHYSICAL AND MEDICAL TREATMENT OF 

CHILDREN. Tenth edition. In one volume, octavo, 548 pages. {Just Issued.) 

BY THE SAME AUTHOR. 

A TREATISE ON THE DISEASES OF FEMALES. Tenth edition. In 

one volume, octavo, 532 pages, with plates. {Just Issued.) 



DICKSON (PROFESSOR S. H.), M.D. 
ESSAYS ON LIFE, SLEEP, PAIN, INTELLECTION, HYGIENE, AND 

DEATH. In one very handsome volmne, royal 12mo. 



DANA (JAMES D). 

ZOOPHYTES AND CORALS. In one volume, imperial quarto, extra cloth, 

with wood-cuts. 

ALSO, 

AN ATLAS TO THE ABOVE, one volume, imperial folio, witli sixty-one mag- 
nificent plates, colored after nature. Bound in half morocco. 

ALSO, 

ON THE STRUCTURE AND CLASSIFICATION OF ZOOPHYTES. 

. Sold separate, one vol., cloth. 



DE LA BECHE (SIR HENRY T.), F. R. S., &c. 
THE GEOLOGICAL OBSERVER. In one very large and handsome octavo 

volume, of 700 pages. With over three hundred wood-cuts. {Just Issued.) 



AND SCIENTIFIC T U BLI C A T I ONS. 



11 



DRUITT (ROBERT), M.R. C.S., &c. 
THE PRINCIPLES AND PRACTICE OF MODERN SURGERY. A now 

American, Cvom the la^^t aiul improved London edition. Edited by F. W. Sar(;ent, M. P., 
author of " Elinor Snrgerv," ».\:c. Ilhislrated vvitli one lumdied and ninety-three wood-engrav- 
mg:?. In one very handsjomely printed octavo volume, of 570 large pages. 



, No work, in our opinion, equals it in presenting 1 
so much vnhiable surarical niatier in so small a 
compass. — St. Louis Med. and Surgical Journal. 

Druitt's Surgery is too well known to the Ameri- 
can medical profession to require its announcement 
anywhere. Probably no work of the kind has ever 
been more cordially received and extensively circu- 
lated than this The fact that it comprehends in a 
comparatively small compass, all the essential ele- 
ments of theoretical and practical Surgery — that it 
is I'ound to contain reliable and authentic informa- 
rion on the nature and treatment of nearly all surgi- 
cal affections — is a sufficient reason for the liberal 
patronage it has obtained. The work before us is a 
new edition, greatly enlarged and extended by the 
author — its practical part having undergone a tho- 
rough revision, with fiftv pa^cs of additional matter. 
The editor, Dr. F. \V. Sargent, of Philadelphia, has 
contributed much to enhance the value of the work. 
by such American improvements as are calculated 
more perfectly to adapt it to our own views and 
practice in tliis country. It abounds everywhere 
with spirited and life-like illustrations, which to the 
young surgeon, especially, are of no minor consi- 
deration. Every medical man frequently needs just 
such a work as this, for immediate reference in mo- 
ments of sudden emergency, when he has not time to 
consult more elaborate treatises. Its mechanical 
execution isof the v^ery best quality, and as a whole, 
it deserves and will receive from the profession, a 
liberal patronage. — The Oiiio Medical and Surgical 
Journal. 

The author has evidently ransacked every stand- 
ard treatiseof ancient and modern times, and all that 
is really practically useful at the bedside wall be 
found in a form at once clear, distinct, and interest- 
ing. — Edinburgh Monthly Medical Journal. 

Druitt's work, condensed, systematic, lucid, and 
practical as it is, beyond most works on Surgery 



accessible to the American student, has had much 
currency in this country, and under its present au- 
spices pr(muses to rise to yet higher favor. The il- 
lustrations of the volume are good, and, in a word, 
the publishers have acquitted themselves fully of 
their duty. — The Western Journal of Medicine and 
Surgery. 

The most accurate and ample resume of the pre 
sent state of Surgery that we are acquainted with— 
Dublin Medical Journal. 

A better book on the principles and practice of 
Surgery as now understood in England and Americ:' , 
has not been given to the profession. — Boston Medi- 
cal and Surgical Journal. 

An unsurpassable compendium, not only of Sur- 
gical, but of Medical Practice. — London Medical 
Gazette. 

This work merits our warmest commendations, 
and we strongly recommend it to young surgeons as 
an admirable digest of the principles and practice of 
modern Surgery. — Medical Gazette. 

It may be said with truth that the work of Mr. 
Druitt affords a complete, though brief and con- 
densed view, of the entire field of modern surgery. 
We know of no work on the same subject having the 
appearance of a manual, which includes so many 
topics of interest to the surgeon ; and the terse man- 
ner in which each has been treated evinces a most 
enviable quality of mind on the part of the author, 
v/ho seems to have an innate power of searching 
out and grasping the leading facts and features of 
the most elaborate productions of the pen. It is a 
useful handbook for the practitioner, and we should 
deem a teacher of surgery unpardonable who did not 
recommend it to his pupils. In our own opinion, it 
is admirably adapted to the wants of the student — 
Provincial Medical and Surgical Journal. 



DUNGLI30N, FORBES, TWEEDIE, AND CONOLLY. 
THE CYCLOPAEDIA OF PRACTICAL MEDICINE: comprising Treatises on 

the Nature and Treatment of Disease:^, Materia Medica, and Therapeutics, Disea.ses of Women 
and Children, Medical Jurisprudence, &rc. &c. i\\ four large super royal octavo volumes, of 
3254 double-columned pages, strongly and handsomely bound. 



no less than four hundred and eighteen distinct treatise.' 
sixty-eight distinguished physicians. 



contributed by 



The most complete work on Practical ISIedicine | 
extant; or, at least, in our language.— Si<#'aZo 
Medical and Surgical Journal. 

For reference, it is above all price to every prac- 
titioner. — Western Lancet. 

One of the most valuable medical publications of 
the day — as a work of reference it is invaluable. — i 
Western Journal of Medicine and Surgery. 

It has been to us, both as learner and teacher, a ' 
v.'orkfor ready and frequent reference, one in which j 
modern English medicine is exhibited ia the most 
advantageous light. — Medical Examiner. ! 

"We rejoice that this work is to be placed within \ 
the reach of the profession in this country, it l)eing 



unquestionably one of very great value to the prac- 
titi(mer. This estimate of it has not been formed 
from a hasty examination, but after an intimate ac- 
quaintance derived from frequent consultation of it 
during the past nine or ten years. The editors are 
practitioners of established reputation, and the list 
of contributors embraces many of the most eminent 
professtu's and teachers of London, Edinburgh, Dub- 
lin, and Glasgow. It is, indeed, the great merit of 
this work that tlie principal articles have been fur- 
nisherl by practitioners who have not only devoted 
especial a ttentiou to the diseases about which they 
have written, but ha^'e also enjoyed opportunities 
for an extensive practical acquaintance with them, 
and whose reputation carries the assurance of their 
competency justly to appreciate the opinions of 
others, while it stamps their own doctrines with 
high and just authority. — American Medical Journ. 



DUNGLISON (ROBLEY), M.D., 

Professor of the Institutes of Medicine, in the Jefferson Medical College, Philadelphia. 

HUMAN HEALTH; or, the Influence of Atmosphere and Locality, Change of 

Air and Climate, Seasons, Food, Clothing, Bathing, Exercise, Sleep, &c. &c , on Healthy Man ; 
constituting Elements of Hygiene. Second edition, with many modifications and additions. In 
one octavo volume, of 464 pagets. 



32 



BLANC HARD & LEA'S MEDICAL 



DUNGLISON (ROBLEY), M. D., 

Professor of Insliiutes of Medicine in the Jefferson Medical College, Philadelphia. 

MEDICAL LEXICON; a Dictionary of Medical Science, containin^r a concise 

Explanation of the various Subjects and Terms ofPhysioIogy, Pathology, Ilvgiene, Therapeutic?, 
Pharmacology, Obstetrics, Medical Jurisprudence, &:c. With the French aiid other Synonymes ; 
Notices of Climate and of celebrated Mitieial Waters; FormulfB for various Officinal, "EmpiricaL 
and Dietetic Preparations, etc. Tenth edition, revised. In one very (hick octavo volume, ot 
over nine hundred large double-columned pages, strongly bound in leather, with raised bands. 
{Just Issued.) 

Every successive edition of this work bears the marks of the industry of the author, and of his 
determination to keep it fully on a level with the most advanced slate of medical science. Thus 
the last two editions contained about nine thous.\nd subjkcts andteriws not cojnprised m the one 
immediately preceding, and the pre.'^ent has not less than four tkotjsand not in any former edition. 
As a complete Medical Dictionary, therefore, embracing over FIFTY THOUSAND DEFINI- 
TIONS, in all the branches of the science, it is presented as meriting a continuance of the great 
favor and popularity which have carried it, within no very long space (>f time, to a ninth edition. 

Every precaution has been taken in the preparation of "the present volume, to render its mecha- 
nical execution and typographical accuracy worthy of its extended reputation and universal use. 
The very extensive additions have been accommodated, without materially increasing the bulk of 
the volume by the employment of a small but exceedingly clear type, cast for this purpose. The 
press has been watched with great care, and every effort used toinsure tlie v'erbal accuracy so ne- 
cessary to a work of this nature. The whole is printed on fine white paper ; and, while thus exhi- 
biting in every respect so great an improvement over former issues, it is presented at the original 
exceedingly low price. 



)as I 

written able and voluminous works on nearly every 
branch of medical science. There could be no more 
useful book to the student or practitioner, in the 
present advancing age, than one in which would be 
found, in addition to the ordinary meaning and deri- 
vation of medical terms — so many of Avhlch are of 
modern introduction — concise descriptions of their 
explanation and employment ; and all this and much 
more is contained in the volume before us. It is 
thereft)re almost as indispensable to the other learned 
professicms as to our own. In fact, to all who may 
have occasion to ascertain the meaning of any word 
belonging to the many branches of medicine. From 
a careful examination of the present edition, we can 
vouch for its accurac^s and for its being brought 
quite up to thedateof publicaticm ; tlie author states 
in his preface that he has added to it about four thou- 
sand terms, which are not to be found in the prece- 
ding one. — Dublin Quarterly Journal of Medical 
Sciences. 

On the appearance of the last edition of this 
valuable work, we directed the attention of our 
readers to its peculiar merits; and we need do 
little more than state, in reference to the present 
reissue, that, notwithstanding the large additions 
previously made to it, no feAver than four thou- 
sand terms, not to be found in the preceding edi- 
tion, are contained m the volume brfore ns. — 
Whilst it is a wonderful monument of its author's 
erudition and industry, it is also a work of great 
practical utility, as Ave cnn testify from our own | 
experience; for we keep it constantly witiiin our 
reach, and make very frequent reference to it, 
nearly always finding in it the information we seek. 
— British and Foreign Med.-Chirurg. Revieiv. 

It has the rare merit that it certainly has no rival ; 
in the English Innguage for accuracy and extent i 
of references. The' terms generally include short! 
physiological and pathological descriptions, so that. ' 
as the author justly observes, the reader does not 
possess in this work a mere dictionary, but a book, | 
which, while it instructs him in medical etymo- 
logy, furnishes him with a large amount of useful | 
information. The author's labors have been pro- j 
perly appreciated by his own countrymen : and we I 



can only confirm their judgment, by recommending 
this most useful volume to the notice of our cisat- 
lantic readers. JNo medical library will be complete 
without it. — London Med. Gazette. 

It is certainly more complete and comprehensive 
than any with which Ave are acquainted in the 
English language. Few, in fact, could be found 
better qualified than Dr. Dunglison for the produc- 
tion of such a VA^ork. Learned, industrious, per- 
severing, and accurate, he brings to the task all 
the peculiar talents necessary for its successful 
performance; Avhile. at the same time, his fami- 
liarity AAHth the writings of the ancient and modern 
" masters of our art,''^ renders him skilful to note 
the exact usage of the several terms of science, 
and the various modifications aaMiIcIi medical term- 
inology has undergone Avith the change of theo- 
ries or the progress of improvement. — American 
Journal of the Medical Sciences. 

One of the most complete and copious knoAvn to 
the cultivators of medical science. — Boston Med. 
Journal, 

A most complete Medical Lexicon — certainly one 
of the best AA^orks of the kind in the language. — 
Charleston Medical Journal. 

The most complete Medical piclionary in the 
English language. — Western Lancet. 

It has not its superior, if indeed its equal, in the 
English language. — St. Louis Medical and Surgical 
Journal. 

Familiar ^v\th nearly all the medical dictiona- 
ries noAV in print, aa'c consider tlie one before us 
the most comj-dete, and an indispensable adjunct to 
every medical library. — British American Medical 
Journal. 

■\Ve repeat our declaration, that this is the best 
Medical Dictionary in the language. — West. Lancet. 

The very best Medical Dictionary now extant.— 
Southern Medical and Surgical Journal. 

The most comprehensive and best English Dic- 
tionary of medical terms extant. — Buffalo Medical 
Journal. 



BY THE SAME AUTHOR. 



THE PHACTTCE OF MEDICINE. A Treatise on Special Pathology and The- 

rapeutics. Third Edition. In two large octavo A'oluraes, of fifteen hundred pages. 



Upon CA'ery topic embraced in the AA'ork the latest i ferings of the race.- 
information Avill be found carefully posted up. — | Journal. 
Medical Examiner . \ 



-Boston Medical and Surgical 



It is certainly the most complete treatise of Avhich 
AA-e have any knowledge. — Western Journal of Medi- 
cine and Surgery. 



The student of medicine will find, in these tAA^o 
elegant volumes, a mine of facts, a gathering of 
precepts and advice from the Avorld of experience, I 
that will nerve him Avith courage, and faithfully One of the most elaborate treatises of the kiud 
direct him in his efforts to relieve the physical suf- ' Ave have. — Soiitiiern Med. and Surg. Journal. 



AND SCIENTIFIC PUBLICATIONS. 



11 



DUNGLISON (ROBLEY), M.D., 

Professor of lustitutes of Medicine in the Jeiierson Medical College, Philadelphia. 

HUMAN PHYSIOLOGY. Seventh edition. Thoroughly revised and exten- 
sively modified and enlarged, witii nearly five hundred illustrations. In two large and hand- 
somely printed octavo volumes, containing- nearly 14.30 pages. 

On no previous revision of this work has the author bestowed more care than on the present, 
it having been subjected to an entire scrutiny, not only as regards the important matters of 
which it treats, but also the language in which they are conveyed; and on no former occasion 
has he felt as satisfied with his endeavors to have the work on a level with the existing state of 
the science. 



It has long since taken rank as one of the medi- 
cal classics of our lanpruage. To say that it is liy 
f;ir the best text-book of physiology ever published 
in this country, is but echoing the general testi- 
mony of the profession. — N. Y. Journal of Medicine. 

There is no single book we would recommend to 
the student or physician, w^ilh greater confidence 
than the present, because in it, will be found a mir- 
ror of almost every standard physiological work of 
the day. We most cordially recommend the work 
.to every member of the profession, and no student 
should be without it. It is the completest work on 



Physiology in the English language, and is highly 
creditable to the author and publisliers. — From the 
Canadian Medical Journal. 

The most complete and satisfactory system of 
Physiology in the English language.— J.//ter. Med. 
Journal. 

The best work of the kind in the English lan- 
guage. — Silliman''s Journal. 

The most full and complete system of Pliysiology 
in our language. — Western Lancet. 



BY THE SAME AUTHOR. 

GENERAL THERAPEUTICS AND MATERIA MEDIC A; adapted for a 

Medical Text-book. Fifth edition, much improved. With one hundred and eighty-seven illus- 
trations. In two large and handsomely printed octavo vols., of about 1100 pages. (Now Ready.) 

The new editions of the United States Pharmacopoeia and those of London and Dublin, have ren- 
dered necessary a thorough revision of this work. In accomplishing this the author has spared no 
pains in rendering it a complete exponent of all that is new and reliable, both in the departments 
of Therapeutics and Materia Medica. The book has thus been somewhat enlarged, and a like im- 
provemeul will be found in every department of its mechanical execution. 

In this w^ork of Dr. Dunglison, -w^e recognize the 
same untiring industry in the collection and em- 
bodying of facts on the several subjects of u'hich he 
treats, "that has heretofore distinguished him, and 
we cheerfully point to these volumes, as tw^o of the 
most interesting that we know of. In noticing the 
additions to this, the fourth edition, there is very 
little in the }'eiiodical or annual literature of the 
profession, published in the interval which has 
elapsed since the issue of the first, that has escaped 
the careful search of the author. As a book for 
reference, it is invaluable. — Charleston Med. Jour- 
nal and Review. 



As a text-book for students, for whom it is par- 
ticularly designed, we know of none superior to 
it. — St. Louis Medical and Surgical Journal. 

It purports to be a new edition, but it is rather 
a new book, so greatly has it been improved, both 
in the amount and quality of the matter which it 
contains. — N. O. Medical and Surgical Journal. 

We bespeak for this edition, from the profession, 
an increase of patronage over any of its former 
ones, on account of its increased merit. — N. Y. 
Journal of Medicine. 



It may he s:iid to be tke work now upon the sub- "SVe consider this work unequalled, 
jects upon which it treats. — Western Lancet. i and Surg. Journal. 



-Boston Med. 



BY THE SAME AUTHOR. 

NEW REMEDIES, WITH FORMULA FOR THEIR ADMINISTRATION. 

Sixth edition, with extensive Additions, la one very large octavo volume, of over 7-50 pages. 

One of the most useful of the author's works. — 
Southern Medical and Surgical Journal. 

This \vell-knowTi and standard book has now 
readied its sixth edition, and has been enlarged and 
improved by the introduction of all the recent gifts 
to therapeutics which ihe last few years have so 
richly produced, including the anaesthetic agents, 
&c. This elaborate and useful volume should be 
found in every medical library, for as a book of re- 
ference, for physicians, it is unsurpassed by anv 
other work in existence, and the double index for 



diseases and for remedies, v,n\\ be found greatly to 
enhance its value. — New York Med. Gazette. 

The great learning of the author, and his remark- 
able industry in pushing his researches into every 
source Vtrhence information is derivable, has enabled 
him to throw together an extensive mass of facts 
and statements, "accompanied by full reference to 
authorities; which last feature renders the work 
practically valuable to investigators wlio desire to 
examine the original papers. — Tke American Journal 
of Pkarmacy. 



DUFTON (WILLIAM), M.R.C.S., &.c. 
THE NATURE AND TREATMENT OF DEAFNESS AND DISEASES 

OF THE EAR; and the Treatment of the Deaf and Dumb. One small 12mo. vol. pp. 120. 



DURLACHER (LEWIS). 
A TREATISE ON CORNS, BUNIONS, THE DISEASES OF NAILS, 



AND THE 
pp. 134. 



GENERAL MANAGEMENT OF THE FEET. In one 12mo. volume, cloth. 



14 BLANCHARD & LEA'S MEDICAL 



DE JONGH (L. J.), M. D., &c. 
THE THREE KINDS OF COD-LIVER OIL, comparatively considered, with 

their Chemical and Therapeutic Properties. Translated, with an Ap|)endix and Cases, by 
Edward Carey, M D. To wliicli is added an article on the subject from "Diinglison on New 
Remedies." In one small r2nio. volume, extra cloili. 



DAY (GEORGE E.), M. D. 
A PRACTICAL TREATISE ON THE DOMESTIC MANAGEMENT AND 

MOPvE IMPORTANT DISEASES OF ADVANCED LIFE. With an Appendix ou a new 
and successful mode ol treating Ijumba^o and other forms of Chronic Rheumatism. One volume, 
oetavoj '2:26 pages. 



ELLIS (BENJAMIN;, M.D. 
THE MEDICAL FORMULARY: being a Collection of Prescriptions, derived 

from the writings and practice of many of the mo--t eminent physicians of America and Europe. 
Together with the usual Dietetic Preparations and Antidotes for Poisons. To which is added 
an .Appendix, on the Endermic use of 3Iedicines, and on the use of Eiher and Chloroform. The 
whole accompanied with a few brief Pharmaceutic and Medical Observations. Tenth edition, 
revised and much exieruied by Robert P. Thomas. ]M. D., Professor of ^Materia 3Iedica in the 
Philadelphia College of Pharmacy. In one neat octavo volume, of two hundred and ninety-six 
pages. {7^0 Ji' Read I/.) 

This work has received a ver}- complete revision at t4ie hand< of the editor, who has made what- 
ever alterations and additions the progress of medical and pharmaceutical science has rendered ad 
visable. introducins: fully the new remedial agents, and revi.-ing the whole by the latest improvements 
of the Pharmacop<i?ia. To accommodate these additions, the size of the page has been increa>ed. 
and I he volume itself considerably enlarged, while every etibrt has been made to secure the typo- 
graphical accuracy which has so long merited the i-onfidence of the profession. 



ERICHSEN (JOHN). 

Professor of Surgery in Universitv College. London. &c. 

THE SCIENCE AND ART 6f' SURGE RY; being a Treatise ox Surgical 

Injuries, Diseases. AND Opkeations. la one very large and handsome octavo A'olume. with 
titjO illustrations. (Nearly ReadTj .) 



FERGUSSON (WILLIAM), F. R. S., 

Professor ox Surgery in King's College, London, &c. 

A SYSTEM OF PRACTICAL SURGERY. Fourth American, from the third 

and enlarged London edition. In one large and beautifully printed octavo volume, of about seven 
himdred pages, with three hundred and ninety-three handsome illustrations. (Now Ready.) 

The most important suhjects in connection with Avhether he confines himself more strictly to the 
practical surgexy Aviiich have l)een more recently operative department, or t'olhnvs surgerv on a more 
hnuiglit under the notice of, and discussed by. the comprehensive scale.— J/e(f/ca^ Times and Gazette. 
surgeons of Great Hrit:nn. are I'ullv and dispassion- ' -^ , -^^ ■, ■ ■. 

suelv consideied bv Mr. Fer-nsson. and that which i ^" ^^:"''^ ^as e^er written which more nearlv 
Avas before wanting has now been supplied, so that comprehended the necessities of the student and 



practitioner, and was more carefully arranged t( 
that singlepurpose than this. — N. Y. Med. and Surg. 
Journal. 



Ave can now look upon it as a work on practical sur- 
gery instead of one on operative surgerj- alone, 
which many have hitherto considered it to be. And 
As-e think tlie author has shown a wise discretion in \ The addition of many new pages makes this work 
iriaKing tlie additions on surgical disease ^vhich are more trian ever indispensable to tiie studentand prac- 
to be "found in the presentvolume, and has very , titioner. — Ranking' s Ahstrntt, iaxixydTy. 1853. 
much enhanced its value: t'or, besides two elaborate 1 t- ^i_ ^ .• • i_ , . , 

chapters on the diseases o( bones and jr.ints, Avhich ^or the general practitioner, who does not mnke 
Avere Avantin? before he has headed each chief sec- p„ specialtv of surgery, it is certain y invaluable 



)n of the Avork by a general description of the sur- 



The style is concise, pointed, and clear. Tne de- 



gical disease and 'injury of that region of the body ' scnptions oi the various operations are concentrated 
which is treated of m each, prior to entering into the' =i°.d nccurate, so that in cases of emergency, the 
consideration of the more special morbid conditions principles oj the most difficult operations may be 
and their treatment. There is also, as in former : obtained by a reierence of a lew moments to its 
editions, a sketch of the anatomy of particular re- i pages. — Western Lancet. 

gions. "We have no\\^ pointed out some of the prin- j Among the numerous Avorks upon surgery pub- 
cipal additions in this AA-ork. There was some I lished of late years, Ave knoAv of none we A'^alue 
ground formerly for the complaint before alluded to. more highly than the one before us. It is perhaps 
that it dwelt too exclusively on operative surgery ; ; the very'best v.-e have for a text-book and for ordi- 
but this defect is now removed, and the book is more ; nary reference, being coucise and eminently practi- 
than ever adapted for the purposes of the practitioner, ■ cal. — Southern Med. and ::urg. Journai. 



M. D. 
RENAL AFFECTIONS; their Diagnosis and Pathology. With illustrations. 

One volume, royal 12mo., extra cloth. 



GUTHRIE (G. JJ, F. R. S., &c. 

THE ANATOMY OF THE BLADDER AND URETHRA, and the Treat- 
meat of the Obstructions to which those Passages are liable. In one A-olurae, octavo, 150 pages. 



AND SCIENTIFIC TUBLI C AT I OXS, 



]r, 



FOWNES (GEORGE), PH. D., &c. 
ELEMENTARY CHEMISTRY; Theoretical and Practical. With numerous 

illustrations A now American, from the last and rovi.-ed London edition. Ediied, with Addi- 
tions, by Robert Bridges, M. D. In one large royal I2mo. volume, of over 5-30 pages, willi ISl 
wood-cuts, sheep, or extra cloth. {Jii.'it Ready.) 

The lamented death of the author has caused the revision of this edition to pass into the hand-* of 
those distingui.-hed chemi>ts, H. Bence Jones and A. W. Hodman, who have fully sustained ii< 
reputation by the additions which they liave made, more especially in the p;>rtion devoted to Organic 
Chemistry, considerablv increasing the size of the volume. This labor has been so thoroughly 
l>ertbrmed, that the American Etiitor has found but lijtle to add, his notes consist ins: chiefly of sucii 
matters as the rapid advance of the science has rendered necessary, or of uivestigalions which had 
apparently been overlooked by the author's friends. 

The volume is therefore again presented as an exponent of the most advanced state of chemical 
science, and as not unworthy a continuation oi the marked favor which it has received as an ele- 
mentary text-book. 



The work of Dr. Fownes has loni? been before , 
the public, and its merits have been fully appreci- 
ated as the best text-book ou chemistry now in '' 
existence. We do not, of course, place it in a rank ' 
superior to the works of Brande, Graham, Turner, 
Gregory, or Gmelin, but we say that, as a work I 
fiir students, it is preferable to any of them. — Lon- 
4on Journal of Medicine. | 

A work well adapted to the wants of the student. 
It is an excellent exposition of the chief doctrines 
and facts of modern chemistry. The size of the work. 
and still more the condensed yet perspicuous style 
in which it is written, absolve it from the charges : 
very properly urged against most manuals teruled j 



popular, viz.: of omitting details of indispcnsabi'^ 
importance, of avoiding technionl difficulties, in- 
stead of explaining them, and of treating subjects 
of high scientific interest in an unscientific way. — 
Edinburgli Monthly Journal of Melical Science. 

The rapid sale of this Manual evinces its adapta- 
tion to tiie wants of the student of chemistry, whilst 
the welJ-known merits of its lamented author have 
constituted a guarantee for its value, as a faitht'ul 
exposition of the general principles and nmst im- 
portant facts of tlie science to Avhioh it professes to 
be an introduction. — British and Foreign Medico- 
Chirurgical Review. 



GRAHAM (THOMAS), F. R. S., 

Professor of Chemistry in University College, London, &c. 

THE ELEMENTS OF CHEMISTRY. Including the application of the Science 

to the Arts. With numerous illustrations. With 2\otes and Additions, by Robert Bridges. 

M. D., &c. &c. Second American, from the second and enlarged London edilion 
PART I. {Lately Issued) large 8vo., 430 pages, 185 illustrations. 
PART II. {Prepari?ig) to match. 

The great changes which the science of chemistry has undergone within the last few years, ren- 
der a new edition of a treatise like the present, almost a new work. The author has devoted 
several years to the revision of his treatise, and has endeavored to embody in it ever}' fact and 
inference of importance which has been observed and recorded by the great body of chemical 
investigators who are so rapidly changing the face of the science. In this manner the work has 
been greatly increased in size, and the number of illustrations doubled ; while the labors of the editor 
have been directed towards the introduction oi such matters as have escaped the attention of the 
author, or as have arisen since the publication of the first portion of this edition in London, inlS'^O. 
Printed in handsome style, and at a very low price, it is therefore confidently presented to the pro- 
fession and the student as a very complete and thorough text-book of this important subject. 



GROSS (SAMUEL D.), M. D., 

Professor of Surgery in the Louisville Medical Institute, &e. 

A PRACTICAL TREATISE ON THE DISEASES AND INJURIES OF 

THE URINARY ORGANS. In one large and beautifully printed octavo volume, of over seven 
hundred pages. With numerous illustrations. 



A volume replete with truths and principles of the 
utmost value in the investigation of these diseases. — 
American Medical Journal. 



guished autlior will doubtless receive their warmest 
congrntulations that he lias succeeded in producing 
a treatise so creditable to himself, and, as we hum- 
bly believe, to American surgical literature. — N. Y. 
Jo u rnal of Medic ine . 



It has remained for an American Avriter to wipe 

away this reproach ; and so completely has the task: 

! been falfilied, that we venture to predict for Dr. 

I Gross's treatise a permanent place in the literature 

I of surgerv. worthv to rank with the best works of 



Dr. Gr'ss has brought all his learning, experi- 
ence, tact, and judgment to the task, and has pro- 
duced a work Avortliy of his high reputation. We 
feel perfectly safe in recommending it to our read- 
ers us a monograph unequalled "in interest and 
practical value by any other on the subject in our 
language; and we cannot help saving, that we es- 

teem it a matter of just pride, that another work ; ^j^^ ^ ^ ^^^ j . 

so creditable to our country has been contributed | ^ ^^^ j^| ^^ ^,^^ ^ >^ . credftable 

*''V"'T^'^?'''''^''^''■'*;"'■^l7^ ''^'Ti ■' ito tranlatlanUc enterprise; the paper and print 

-Tne Western Journal of Medicine and Surgery. j ^^.^,^|^ docredit to a first-rate London establishment : 
We regret that our limits preclude such a notice I and the numerous wood-cuts which illustrate it, de- 
as this valuable contribution to our American ' '""nstraie that America is making rapid advances in 
Medical Literature merits. We have only room I this department of art. ^Ve have, indeed, unfeigned 
to say that the author deserves the thanks of the | pleasure in congratulating all concerned in this pu 
profession for this elaborate production; whicl 



cannot fail to augment the exalted reputation ac- 
quired by his former %vorks, for which he has been 
honored at home and abroad. — N. Y. Med Gazette. 

Whoever will peruse the vast amount of valuable 
practical information it contains, and wliich we 
have been unable even to notice, will, we think, 
agree with ns, that there is no work in the English 
language which can make any just pretensions to 



lication, on the result of tlieir labours; and expe- 
rience a feeling something like what animates a long- 
expectant husband man. who, of ten times disappointed 
by the produce of a favorite field, is at last agree- 
ably surprised by a stalely crop which may bear 
comparison with any of its former rivals. The 
grounds of our high appreciation of the work will 
be obvious as we proceed; and we doubt not that: 
the present facilities for obtaining American books 
will induce many of our readers to verify our rt 



be Its equal. Secure in the esteem and coufidencc ' commendation by their own perusal of it. — British 
of the profession in this country, at least, its distin- ' and Foreign Medico-Chirurgical Review. 



16 



EL AX CHARD !c LEA'S MEDICAL 



GRIFFITH (JOHN WILLIAM), M. D., &.c. 
A PRACTICAL MANUAL OX THE BLOOD AND SECRETIONS OF 

TPLE HUMAN BODY. Royal 12mo., with plates. (See " Manuals vn Blood and Urine.") 



GLUGE (GOTTLIEB), M. D., 

Professor of Physiology and Patliological Anatomy in the University of Brussele, SiC. 

AN ATLAS OF PATHOLOGICAL HISTOLOGY. Tran.«^lated, ^vitli Notes 

and Additions, by Joseph Leidy, ^L D., Professor of Anatomy in the University of Pennsylva- 
nia. In one volume, very large imperial quarto, with three hundred aud tweniy figures, plain 
and colored, on twelve copperplates. 

AVe are triad to see this excellent work of Gln^e j 
translated "into English by so competent a hand, and | 
put withm the reach of the profession in this coun- ' 
try. The history of the development and changes of ' 
the elements of pathological tissues, has become ; 
now a necessary introduction to the study of morbid : 
anatomy. 1 1 can no longer be looked upon as merely 
accessory. Bearing the same relation to it as does 
normal histology to normal anatomy, it appears to ; 
lis to be of still' higher importance, since it has a j 
closer aud more direct bearing upon practical inedi- j 
cine. Whatever makes our knowledge of diseased 
structure clearer, must throw light also upon the 
plan of cure, and show us, too. in m.any instances, '■ 
where a cure is impossible. This being, as far as 
-we know, the only work in Avhich pathological his- 
tology is separately treated of in a comprehensive 
manner, it will, we think, for this reason, be of infi- 1 



nite service to those who desire to investigate the 
subject systematically, and who have ftlt the diffi- 
culty of arranging in their mind the unconnected 
observations of a great number of autliors. The 
development of the morbid tissues, and the formation 
of abnormal products, may now be followed and 
studied with the same ease and satisfactiou as the 
best arranged system of physiology. — American 
Med. Journal. 

Professor Gluge's work will be found a very valu- 
able additiim to the micrologist's collection. It 
contains, in the compass of one volume, a concise 
description and well-executed illustrations of tlie 
elements to be observed under the mien-scope in the 
principal pathological lesions. — Dublin Quarterly 
Journal of Medical Science. 



GRIFFITH (ROBERT E.), M. D., &,c. 

A UNIVERSAL FORMULARY, containing the methods of Preparin.s and Ad- 
ministering Officinal and other Medicines. The whole adapted to Physicians and Pharmaceu- 
tists, lu one large octavo volume, of 568 pages, double columns;. 



Dr. Griffith's Formulary- is worthy of recommen- 
dation, not only on account of the care which has 
been bestowed on it by its estimable author, but for 
its general nccuracy, and the richness of its details. 
— Medical Examiner . 

Most cordially we recommend this Universal 
Formulary, not forgetting its adaptation to drug- 
gists and apothecaries, who Ti-ould find themselves 
vastly improved by a t'amiliar acquaintance ^x\lh 
this every-day book of medicine. — The Boston Med. 
and Surg. Journal. 

A very useful work, and a most complete compen- 
dium on the subject of materia medica. AVe know 
of no "work in our language, or any other, so com- 
prehensive in all its details. — London Lancet. 



Pre-eminent among the best and most useful com- 
pilations of the present day "v\'ill be found the work 
before us, which can have been produced only at a 
very great cost of thought and labor. A short de- 
scription will suffice to" show that Tve do not put 
too high an estimate on this Avork. VTe are n(U cog- 
nizant of the existence of a parallel work. Its value 
will be apparent to our readers from the sketch of 
its contents above given. We strongly recommend 
it to all Avlio are eneaged either in practical medi- 
cine, or more exclusively with its literature. — Land. 
Med. Gazette. 

A valuable acquisition to the medical pTactitioner, 

and a useful book of reference to the apothecary on 
numerous occasions. — Anier. Journal of Fharmacy. 



BY THE SAME ArXHOR. 

MEDICAL BOTAXY; or, a Description of all the more important Plants used 

in ]^.Iedicine, and of their Properties, Uses, and IMoues of Adiniaislration. In one large octavo 
volume, of 704 pages, handsomely printed, with nearly 350 illu^tiations on wood. 



One of the greatest acquisitions to American medi- 
cal literature. It should by all means be introduced, 
at the very earliest period, into our medical schools, 
aud occupy a place in the library of every physician 
in the laud. — South-ivestern Medical Advocate. 

Admirably calculated for the physician and stu- 
dent — ■we have seen no w^ork which promises 
greater advantages to the profession. — ^Y. O. Med. 
and Surg. Journal. 



One of the fe^v books which supply a positive de- 
ficiency in our medical literature. — Western Lancet. 

"We hope the day is not distant when this work 
will not only be a text-book in every medical school 
and college in the Union, but find a place in the li- 
brary of every private practitioner. — jY. Y. Journal 
of Medicine. 



GREGORY (WILLIAM), F. R. S. E., 

Professor of Chemistry in the University of Edinburgh, &c. 

LETTERS TO A CAXDID INQUIRER OX AXIMAL MAGXETISM. 

Description and Analysis of the Phenomena. De-ails of Facts and Cases. In one neat volume, 
royal 12mo., e^tra cloth. 



GARDNER (D. PEREIRA), M . D. 

M^EDICAL CHE3IISTRY, for the use of Students and the Profession: being a 
Manual of the Science, with its Applications to Toxicology. Physiology, Therapeutics, Hygiene, 
&c. In one handsome royal 12mo. volume, with iilusiraiions. 



AND SCIENTIFIC PUBLICATIONS. 17 

HASSE (C. E.), M. D. 

AN ANATOMICAL DESCRIPTION OF THE DISEASES OF RESPIRA- 
TION AND CIRCULATION. Translated and Edited by Swaine. In one volume, octavo. 

HARRISON (JOHN), M.D. 
AN ESSAY TOWARDS A CORRECT THEORY OF THE NERVOUS 

SYSTEM. In one octavo volume, 292 pages. 



HUNTER (JOHN). 
TREATISE ON THE VENEREAL DISEASE. With copious Additions, by 

Dr. Ph. Ricord, Surgeon to the Venereal Hospital of Paris. Edited, with additional Notes, by 
F. J. BuMSTEAD, M. D. In one octavo volume, with plates {Noio Raady.) 

From the Translator's Preface. 

•'The school, of which M. Ricord is the head, has, by its adherence to some of the most import- 
ant views of the immortal Hunter, and more particularly by its adoption of Hunter's division of 
constitutional syphilis into two periods, and of his beliet in the non-contagiousness of secondary 
symptoms, acquired for itself the name of Hunlerian. It is not without reason, therefore, that the 
names of these two distinguished authors, though separated by more than half a century, appear 
conjointly on the title-page of this volume. 

" M. Ricord's annotations to Htnitcr''s Treatise on the Venereal Disease were first published at 
Paris, in IS-IO, in connection with Dr. G. Richelot's translation of the work, including the contribu- 
tions of Sir Everard Home and Mr. Babington. In a second edition, which has recently appeared, 
M. Ricord has thoroughly revised his part of the work, bringing it up to the knowledge of the 
present day, and so materially increasing it that it now constitutes full one-third of the volume. 

" This publication has been received with great favor by the French, both because it has placed 
within their reach an important work of Hunter, and also because it is the only recent practical 
"work which M. Ricord has published, no edition of his Traite des JSlaladies Veneriennes having 
appeared for the last fifteen years." 

Besides the translation of M Ricord's Notes, Dr. Bumstead has added such further remarks as 
appeared necessary to render the work a complete and systematic exponent of the most recent views 
on this important subject. As a thorough and practical work, combining the distinguished names 
of Ricord and Hunter, it is therefore presented as possessing ej-pecial claims to the notice and con- 
fidence of the profession. 

Also, HUNTER'S COMPLETE WORKS, with Memoir, Notes, &c. &c. In four neat octavo 
volumes, with plates. 

HORNER (WILLIAM E.), M. D., 

Professor of Anatomy in the University of Pennsylvania. 

SPECIAL ANAT03IY AND HISTOLOaY. Eighth edition. Extensively 

revised and modified. In two large octavo volumes, of more than one thousand pages, hand- 
somely printed, with over three hundred illustrations. 

This work has enjoyed a thorough and laborious revision on the part of the author, with the 
view of bringing it fully up to the existing state of knowledge on the subject of general and special 
anatomy. To adapt it more perfectly to the wants of the student, he has introduced a large number 
of additional wood-engravings, illustrative of the objects described, while the publishers have en- 
deavored to render the mechanical execution of the work worthy of the extended reputation which 
it has acquired. The demand which has carried it to an EIGHTH EDITION is a sutficient evi- 
dence of the value of the work, and of its adaptation to the wants of the student and professional 
reader. 



HOBLYN (RICHARD D.), A. M. 
A DICTIONARY OF THE TERMS USED IN MEDICINE AND THE 

COLLATERAL SCIENCES. Revised, with numerous Additions, from the second London 
edition, by Isaac Hays, M. D., &c. In one large royal 12mo. volume, of four hundred and two 
pages, double columns. 

HOPE (J.), M. D., F. R. S., &.C. 
A TREATISE ON THE DISEASES OF THE HEART AND GREAT 

VESSELS. Edited by Pennock. In one volume, octavo, with plates, 572 pages. 



HERSCHEL (SIR JOHN F. W.), F. R. S., <SiC. 
OUTLINES OF ASTRONOMY. New American, from the third London edition. 

In one neat volume, crown octavo, with six plates and numerous wood-cuts. {Just Issued.) 



JOHNSTON (ALEXANDER KEITH), F. R. S., 8lo. 
THE PHYSICAL ATLAS OF NxVTURAL PHENOMENA. For the use of 

Colleges, Academies, and Families. In one large volume, imperial quarto, har.dsomely and 
strongly bound, with twenty-six Plates, engraved and colored in the best style. Together with 
112 pages of descriptive letter-press, and a very copious Index. 



18 



BLANCHARD & LEA'S MEDICAL 



JONES (T. WHARTON), F. R. S., &c. 
THE PRINCIPLES AND PRACTICE OF OPHTHALMIC MEDICINE 

AND SURGERY. Edited by Isaac Hays, M. D., &c. In one very neat volume, large royal 
12mo., of 529 pages, with four plates, plain or colored, and ninety-eight wood-cuts. 



We are confident that the reader will find, on 
perusal, tliat the execution of tlie work amply fulfils 
the promise of the preface, and sustains, iii every 
l)oint the already hi^^h reputation of tlie author as 
an ophthalmic surt!:eon as well as a physiologist 
and pathologist. The hook is evidently the result 
of much labor and research, and has been written 
with the greatest care and attention ; it possesses 
tliat best quality which a general work, like a sys- 
tem or manual can show, viz. : the quality (^f having 
all the materials vvhencesoever derived, so thorough- 
ly wrought u)), and digested in the author's mind, 
as to come forth with the freshness and impressive- 
ness of an original production. We regret that we 
liave received the hciok at so late a period as pre- 
cludes our giving more than a mere notice of it, as, 



although essentially and necessarily a compilation, it 
contains many things wliich we should be glad to 
reproduce in our pages whether in the shape of new 
pathological views, of old errors corrected, or of 
sound principles of practice in doubtful crises dearly 
laid down. But we dare say most of our readers 
will shortly have an opportunity of seeing these in 
their original locality, as we entertain little douhi 
that this book will become what its author hoped it 
might become, a manual for daily reference and 
consultation by the student and the general practi- 
tioner. The work is marked by that correctness, 
clearness, and precision of style which distinguish 
all the productions of the learned author. — British, 
and Foreign Medical Review. 



JONES (G. HANDFIELD), F. R. S., &. EDWARD H . SI EVEKI N G, M . D. 
A MANUAL OF PATHOLOGICAL ANATOMY. With numerous engravings 



on wood. In one handsome voh 



{Preparijig.) 



KIRKES (WILLIAM SENHOUSE), M. D., 

Demonstrator of Morbid Anatomy at St. Bartholomew's Hospital, &c. 



and 



JAMES PAGET, F. R. S., 

Lecturer on General Anatomy and Physiology in St. Bartholomew's Hospital. 

A MANUAL OF PHYSIOLOGY. Second American, from the second and 

impro.ved London edition. With one hundred and ?ixtj''-five illustrations. In one large and 
handsome royal 12nio. volume, pp.550. {Just Issued.) 



In the present edition, the Manual of Physiology 
has been brought up to the actual condition of tlie 
science, and fully sustains the reputation which it 
has already so deservedly attained. AVe consider 
the w^ork of MM. Kirkes and Paget toconstitute one 
of the very best handbooks of Physiology we possess 
— presenting just such an outline of the science, com- 
prising an account of Its leading facts and generally 
admitted principles, as the student requires during 
his attendance upon a course of lectures, or for re- 
ference whilst preparing for examination. Tlie text 
is fully and ably illustrated by a series of very supe- 
rior wood-engravings, by which a comprehension of 
some of the more intricate of the subjects treated of 
is greatly facilitated. — Am. Medical Journal. 

We need only say, that, -without entering into dis- 
cussions of unsettled questions, it contains all the 
recent improvements in this department of medical 
science. For the student beginning this study, and 
the practitioner who has but leisure to refresh his 
memory, this book is invaluable, as it contains all 



that it is important to know, without special details, 
which are read with interest only by those \vho 
would make a specialty, or desire to possess a criti- 
cal knowledge of the subject. — Charleston Medical 
Journal. 

One of the best treatises that can be put into the 
hands of the student. — London Medical Gazette. 

The general favor with which the first edition of 
this -work was received, and its adoption as a favor- 
ite text-book by many of our colleges, will insure a 
large circulation to this improved edition. It will 
fully meet the wants of the student. — Sott^Aern 
Med. and Surg. Journal. 

Particularly adapted to those who desire to pos- 
sess a concise digest of the facts of Human Physi- 
ology. — British and Foreign Med.-Chirurg. Revieio. 

We conscientiouslv recommend it as an admira- 
ble •' Handbook of Physiology."— Xondon Journal 
of Medicine. 



KNAPP (F.), PH. D., 8ic. 
TECHNOLOGY ; or, Chemistry applied to the xirts and to Manufactures. Edited, 

with numerous Notes and Additions, by Dr. Edmund Ronalds and Dr. Thoimas Pvichardson. 
First American edition, with Notes and Additions, by Prof. Walter 11. Johnson. In two hand- 
some octavo voluraesj printed and illustrated in the highest style of art, with about five hundred 
wood-engravinffs. 



PHYSIOLOGICAL 

In one very large octavo volume. 



LEHMANN. 
CHEMISTPvY. Translated by aEORGE E. Day, M. D. 



[PrejJariug.) 



LEE (ROBERT), M. D., F. R. S., Sec. 
CLINICAL MIDWIFERY; comprising the Histories of Five Hundred and 

Forty-five Cases of Difficult, Pi-elernatural, and Complicated Labor, with Commentaries. From 
the second London edition. In one royal 12mo. volume, extra cloth, of 238 pages. 



LA ROCHE (R.), M. D., 8cc. 



PNEUMONIA AND AUTUMNAL FEVERS IN 

MALARLl. In one handsome octavo volume, of about 4-50 p: 



THEIR RELATION TO 

iges. [Nearly Ready.) 



AND SCIENTIFIC PUBLICATIONS. 19 

LAWRENCE (W.), F. R. S., &c. 
A TREATISE ON DISEASES OF THE EYE. Third American edition, 

much improved and enlarged. Wiih over two hundred illiistralions. By Isaac Hays, M. D., 
t>urgeon to Wills Hospital, Philadelphia, ».Ve. In one very large and handsome octavo volume, 
ol' about nine hundred pages. [Jiist Ready.) 

This work, by far the largest and most comprehensive on the subject wilhin reach of the profes- 
sion in this country, has received an entire revision on the part of the editor. Brought up in this 
manner to the most advanced state of science, and presenting an equal improvement over its prede- 
cessors as regards mechanical execution, it is confidently presented as worthy of the extended repu- 
tation which it has hitherto enjoyed. 

BY THE SAME AUTHOR. 

A TREATISE ON RUPTURES; from the fifth London edition. In one octavo 
volume, sheep, 4S0 pages. 



LEIDY (JOSEPH), M. D. 

Professor of Anatomy in the University of Pennsylvania, &c. 

ATLAS OF PATHOLOGICAL HISTOLOGY. Bj Gottlieb Gluge, M. D. 

Translated from the German, with Additions, by Joseph Lkidy, M. D , Professor of Anatomy 
m the University of Pennsj-lvania. In one vol., large imperial quarto, with 320 figures, plain 
and colored, on twelve plates. 

by the same author. 
HUMAN ANATOMY. Ey Jones Quain, M D. From the fifth London edition. 

Edited by Richard Quain, F. R. S., and William Sharpey, M.D., F.Pv,. S., Professors of 
Anatomy and Physiolocy, in University College, London. Revised, with Notes and Additions, 
by Joseph Leidy, M. D., Professor of Anatomy in the University of Pennsylvania. Complete in 
two large 8vo. vols, of about 1300 pages, beautifully illustrated with over 500 engravings on wood. 



LISTON (ROBERT), F. R. S., <Sic. 
LECTURES ON THE OPERATIONS OF SURGERY, and on Diseases and 

Accidents requiring Operations. Edited, with numerous Additions and Alterations, by T. D. 
Mutter, M. D. In one large and handsome octavo volume, of 566 pages, with 216 wood-cuts. 



We can only sny, in conclusion, that Liston's 
Lectures, with Mutter's additions, should be in 
every surgeon's library, and in every student' s 
hand, who wishes to post up his surgical knowledge 
to the present moment. — N. Y. Journ. of Medicine. 



It is a compendium of the modern practice of Sur- 
gery us complete and accurate as any treatise (^f 
similar dimensions in the English language. — West- 
ern. Lancet. 



LALLEMAND (M.). 
THE CAUSES, SYMPTOMS, AND TREAT3IENT OF SPERMATOR- 

RHCEA. Translated and edited by Henry J. McDougal. In one volume, octavo, 320 pages. 
Second American edition. {Now Ready .) 



LARDNER (DIONYSIU3), D. C. L., &c. 
HANDBOOKS OF NATURAL PHILOSOPHY AND ASTRONOMY. 

First Course, containing Mechanics, Hydrostatics, Hydraulics, Pneumatics, Sound and Optics. 
In one large royal ]2mo. volume, of 750 pages, with 424 wood-cuts. Secoxd Course, containing 
Heat, Electricity, Magnetism, and Galvanism, one volume, large roval 12mo., of 450 pages, with 
250 illustrations. Third Course {just ready), vj\\[ contain Meteorologv and Astronomy, with 
numerous steel-plates and wood-cuts. Revised, with numerous Additions, by the American editor. 

The work furnishes a very clear and satisfactory j factory manner the information they desire— r/ie 



account of our knowledge in the important depart 
ment of science of which it treats. Although the 
medical schools of this country do not include the 
study of physics in their course of instruction, yet 



Virginia Med. and Surg. Journal. 

The present treatise is a most complete digest of 
all that has been developed in relation to the groat; 



no student or practitioner should be ignorant of its forces of nature, Heat, Magnetism, and Electricity 
laws. Besides being of constant application in prac- j Their laws are elucidated in a manner both pleasing 
tice, such knowledge is of inestimable utility in fa- ;ind familiar, and at the same time perfectly intelli- 
cilitating the study of other branches of science. To gible to tlie student. The illustrations are snffi- 
students, then, and to those who, having already en- I cientl}' numerous and appropriate, and altogether 
tered upon the active pursuits of business, are desir- j we c;ui cordially recommend the ^vork as well-de- 
ous to sustain and improve their knowledge of the serving the notice both of the practising physician 
general truths of natural philosophy, we can recorn- | and the student of medicine. — The Med. Examiner . 
mend this work as supplying in a clear and satis [ 



20 



BLANCHARD & LEA'S MEDICAL 



MEIGS (CHARLES D.), M. D., 

Professor of Obstetrics, &c., in the Jefferson Medical College, Pliiladelphia. 

OBSTETRICS: THE SCIENCE AND THE ART. Second edition, revised 

and improved. With one hundred and thirty-one illustrations. In one beautifully printed octavo 
volume, of seven hundred and fifty-two large pages. {Lately Puhlished.) 

The rapid demand for a second edition of this work is a sufficient evidence that it haf» supplied 
a desideratum of the profession, notwithstanding the numerous treatises on the same subject which 
have appeared within the last few years. Adopting a system of his own, the aulhor has combined 
the leading principles of his interesting and difficult subject, with a thorough exposition of its rules 
of practice, presenting the results of long and extensive experience and of familiar acquaintance 
"with all the modern writers on this department of medicine. As an American Treatise on Mid- 
wifery, which has at once assumed the position of a classic, it possesses peculiar claims to the at- 
tention and study of the practitioner and student, while the numerous alterations and revisions 
which it has undergone in the present edition are shown by the great enlargement of the work, 
which is not only increased as to the size of the page, but also in the number. Among other addi- 
tions may be mentioned 

A NEW AND IMPORTANT CHAPTER ON "CHILD-BED FEVER." 



As an elementary treatise — concise, but, withal, 
clear and comprehensive — we know of no one better 
adapted for the use of the student; while the young 
practitioner will find in it a body of sound doctrine, 
and a series of excellent practical directions, adapted 
to all the conditions of the various forms of labor 
and their results, wliich he will be induced, "we are 
persuaded, again and again to consult, and always 



with profit. It has seldom been our lot to peruse a 
w^ork upon the subject, from which we have re- 
ceived greater satisfaction, and which we believe to 
be better calculated to communicate to the student 
correct and definite views upon the several topics 
embraced within the scope of its teachings. — Am, 
Journal of the Medical Sciences. 



BY THE SAME AUTHOR. 

WOMAN : HER DISEASES AND THEIR REMEDIES. A Series of Lee- 

tures to his Class. Second edition, revised. In one large and beautifully printed octavo voliune, 
of nearly seven hundred large pages. 

It contains a vast amount of practical knowledge, 
by one wlio has accurately observed ond retained 
the experience of many years, and who tells the re- 
sult in a free, familiar, and pleasant manner. — Dub- 
lin Quarterly Journal. 

There is an off-hand fervor, a glow, and a warm- 
heartedness infecting the effort of Dr. Meigs, which 
is entirely captivating, and which absolutely hur- 
ries the reader through from beginning to end. Be- 
sides, the book teems with solid instruction, and 
it shows the very highest evidence of ability, viz., 
the clearness with which the information is pre- 
sented. We knf)w of no better test of one's under- 
standing a suliject than the evidence of the power 
of lucidly explaining it. The most elementary, as 
well^ as the obscurest subjects, under the pencil -of 
Prof. Meigs, are isolated and made to stand out in 
such bold relief, as to produce distinct impressions 
upon the mind and memory of the reader. — The 
Charleston Med. Journal. 



Professor Meigs has enlarged and amended this 
great work, for such it unquestionably is, having 
passed the ordeal of criticism at home and abroad, 
but been improved therebj' ; for in tMs new edition 
the author has introduced real improvements, and 
increased the value and utility of the book im- 
measurably. It presents so many novel, bright, 
and sparkling thoughts; such an exuberance of new 
ideas on almost every page, that we confess our- 
selves to have become enamored with the book 
and its author ; and cannot withhold our congratu- 
lations from our Philadelphia confreres, that such a 
teacher is in their service. We regret that our 
limits will not allow of a more extended notice of 
this work, but must content ourselves with thus 
commending it as worthy of diligent perusal by 
physicians as well as students, who are seeking to 
be thoroughly instructed in the important practical 
subjects of ViT^hich it treats. — N. Y. Med. Gazette. 



BY THE SAME AUTHOR. 

OBSERVATIONS ON CERTAIN OF THE DISEASES 

CHILDREN. In one handsome octavo volume, of 214 pages. 



OE YOUNG 



It puts forth no claims as a systematic work, \ 
but contains an amount of valuable and useful mat- ' 
ter, scarcely to be found in the same space in our : 
home literature. It cannot but prove an acceptable 
offering to the profession at large. — N. Y. Journal of , 
Medichie. j 

"^Ve take much pleasure in recommending this ; 
excellent little work to the attention of medical 
practitioners. It deserves their attention, and af- 
ter they commence its perusal, they will not wil- 
lingly abandon it, until they have mastered its 
contents. We read the work while suffering from a i 



carbuncle, and its fascinating pages often beguiled 
us into forgetfulness of ag(niizing pain. May it 
teach others to relieve the afflictions of the young. — 
Western Journal of Medicine and Surgery. 

The work before us is undoubtedly a valuable 
addition to the fund of information which has al- 
ready been treasured up on the subjects in question. 
It is practical, and therefore eminently adapted to 
the general practitioner. Dr. Meigs's works have 
the 'same fascination which belongs to himself. — 
Medical Examiner. 



BY THE SAME AUTHOR. {Preparing.) 

ON THE NATURE, SIGNS, AND TREATMENT 

FEVER. In one handsome octavo volume. 



OF PUERPERAL 



BY THE SAME AUTHOR. {JustReady.) 

A TREATISE ON ACUTE AND CHRONIC DISEASE OF THE NECK 

OF THE UTEllUS. With numerous plates, drawn and colored from nature in the highest 
style of art. In one handsome octavo volume. 

This important monograph will be thoroughly illustrated with colored plates of the pathological 
conditions of the uterus, carefully and accurately executed, from drawings by the author, after na- 
ture. As a work of art, nothing handsomer has as yet been produced in this country. 



AND SCIENTIFIC PUBLICATIONS. 



21 



MILLER (JAMES), F. R. S. E., 

Professor of Surgery in the University of Edinburgh. &c. 

PRINCIPLES OF SURGERY. Third American, from the second and revised 

Edinburgh edition. Revised, with Additions, byF. W. Sargent, M. D., author of " Minor Sur- 
gery," >.Vc. In one large and very beautiful volume, of seven hundred and fifty-two pages, with 
two hundred and forty exquisite illustrations on wood. (Extensively used as a text-book.) 

The publishers have endeavored to render the present edition of this work, in every point of me- 
chanical execution, worthy of its very high reputation, and they confidently present it to the pro- 
fession as one of the handsomest volumes as yet issued in this country. 



This edition is far superior, both in the abundance 
and quality of its material, to any of the preceding. 
AVe hope it will be extensively read, and tlie sound 
principles which are herein taught treasured up for 
future application. The work takes rank witli 
Watson's Practice of Physic ; it certainly does not 
t'all behind that great work in soundness of princi- 
ple or depth of reasoning and research. No physi- 
cian who values his reputation, or seeks the interests 
of his clients, c;!n acquit himself liefore his God and 
the -world without making himself familiar with the 
sound and pliilosophical views developed in the fore- 
going book. — New Orleans Medical and Surgical 
Journal. 

Without donl)t the ablest exposition of the prin- 
ciples of that branch of the healing art in any lan- 



guage. This opinion, deliberately formed after a 
careful study of the first edition, we have had no 
cause to change on examining the second. This 
edition has undergone thorough revision by the au- 
thor ; many expressions have been modified, and a 
mass of new matter introduced. The book is got up 
in the finest style, and is an evidence of the progress 
of typography in our country. — Charleston Medical 
Journal and Review. 

We recommend it to both student and practitioner, 
feeling assured that as it now comes to us, it pre- 
sents the most satisfactory expc^sition of the modern 
doctrines of the principles of surgery to be found in 
any volume in any language. — N. Y. Journal of 
Medicine. 



BY THE SAME AUTHOR. {JVovj Ready.) 

THE PRACTICE OF SURGERY. Third American from the second Edin- 
burgh edition. Edited, with Additions, by F. W. Sargent, M. D , one of the Surgeons to Will's 
Hospital. cVc Illustrated by three hundred and nineteen engravings on wood. In one large 
octavo volume, of over seven hundred pages. 

This new edition will be found greatly improved and enlarged, as well by the addition of much 
new matter as by the introduction of a large and complete series of handsome illustrations. An 
equal improvement exists in the mechanical execution of the work, rendering it in every respect 
a companion volume to the "Principles." 



We had occasion in a former number of this .Jour- 
nal, to speak in deservedly high terms of Professor 
Miller's work on the " Principles of Surgery," and 
we are happy to be able to pronounce an equally 
favorable judgment on the manner in which the pre- 
sent volume is executed. * * * We feel no 
hesitation in recommending Professor Miller's two 
volumes as affording to the student what the author 
intended, namely, a complete text-book of Surgery. 
— British and Foreign Medical Review. 

Although, as we are modestly informed in the 
preface, it is not put forth in rivalry of the excel- 



lent works on Practical Surgery which already 
exist, "we think we may take upon ourselves to say 
that it will form a very successful and formidable 
rival to most of them. — Northern Journ. of Medicine. 

Taken together they form a vei-y condensed and 
complete system of Surgery, not surpassed, as a 
text-book, by any work with which we are ac- 
quainted. — III. and Ind. Med. and Surg. Journal. 

Mr. Miller has said more in a few words than any 
writer since the days of Celsus. — N. O. Med. and 
Surg. Journal. 



MALGAIGNE (J. F.). 

OPERATIVE SURGERY, based on Normal and Pathological Anatomy. Trans- 
lated from the French, by Frederick Brittan, A. B., M. D. With numerous illustrations on 
wood. In one handsome octavo volume, of nearly six hundred pages. 

AVe have long been accustomed to refer to it as one 
of the most valuable text-books in our library. — 
Buffalo Med. and Surg. Journal. 

Certainly one of the best books published on ope- 
rative sargery .—Edinburgh Medical Journal. 



To express in a few vs'-ords our opinion of Mal- 
gaigne's work, we unhesitatingly pronounce it the 
very best guide in surgical operations that has come 
before the profession in any language. — Charleston 
Med. and Surg. Journal. 



MOHR (FRANCIS), PH. D., AND REDWOOD (TH EO PH I LUS). 
PRACTICAL PHARMACY. Comprising the Arrangements, Apparatus, and 

Manipulations of the Pharmaceutical Shop and Laboratory. Edited, with extensive Additions, 
by Prof. William Procter, of the Philadelphia College of Pharmacy. In one handsomely 
printed octavo volmne, of 670 pages, with over 500 engravings on wood. 



It is a book, however, which will be in the hands 
of almost everyone who is much interested in phar- 
maceutical operations, as we know of no other pub- 
lication so well calculated to fill a void long felt. — 
Medical Examiner . 

The book is strictly practical, and describes only 
manipulations or methods of performing the nume- 
rous processes the pharmaceutist has to go through, 
in the preparation and manufacture of medicines, 
together with all the apparatus and fixtures neces- 



sary thereto. On these matters, this work is very 
full and complete, and details, in a style uncom- 
monly clear and lucid, not only the more compli- 
cated and difficult processes, but those not less im- 
pr)rtnntones. the most simple and c(niiinon. — Buffalo 
Medical Journal. 

The country practitioner who is obliged to dis- 
pense his own medicines, will find it a most valuable 
assistant. — Monthly journal and Retrospect. 



22 



BLANCHARD & LEA'S MEDICAL 



MACLISE (JOSEPH), SURGEON. 

SURGICAL ANATOMY. 

FORMING ONE VOLUME, VERY LARGE IMPERIAL QUARTO. 

With Sixty-eight large and splendid Plates, drawn in the test style, and beautifully colored. 
Containing one hundred and ninety Figures, many of them the size of life. 

TOGETHER WITH COPIOUS AND KXPLANATOKY LETTER-PRESS. 

Strongly and handsomely bound in extra cloth, being one of the cheapest and best executed Surgical 
works as yet issued in this country. 

Copies can be sent by mail, in five parts, done up in stout covers. 

This great work being now concluded, the publishers confidently present it to the attention of the 
profession as worfhy in every respect of their approbation and patronage. No complete work of 
ihe kind has yet been published in the English language, and it therefore will supply a want long 
felt in this country of an accurate and comprehensive Atlas of Surgical Anatomy to which the 
student and practitioner can at all times refer, to ascertain the exact relative position of ihe various 
portions of the hmnan frame towards each other and to the surface, as well as their abnormal de- 
viations. The importance of such a work to the student in the absence of anatomical material, and 
to the practitioner when about attempting an operation, is evident, while the price of the book, not- 
withstanding the large size, beauty, and finish of the very numerous illustrations, is so low as tfi 
place it within the reach of every member of the profession. Tlie publishers therefore confidentlv 
anticipate a very extended circulation for this magnificent work. 

I vailed, both for accuracy of dravi^ins^, beauty of 
coloring, and all the requisite explanations of the 
I subject'in hand. To the piihlishers, the profession 
I in America is deeply indebted for placing: such a"^ 
I valuable, such a useful work, at its disposal, and 
j at such a moderate price. It is one of the most 
j finished and complete pictures of Surgical Auato- 
my ever offered to the profession of" America. — 
I With these plates before them, the student and prac- 
I titioner can never be at a loss, under the most despe- 
1 rate circumstances. We do not intend these for 
commonplace compliments. We are sincere; be- 
; cause we know the work will be found invaluable 
to the young, no less than the old, surgeon. AVe 
have not space to point out its beauties, and its 
merits; but we speak of it en masse, as a whole, 
and strongly urge — especially those -who, from their 
position, may be debarred the privilege and opportu- 
nity of inspecting the fresh subject, to furnish them- 
j selves with the entire work. — The New Orleans 
I Medical and Surgical Journal. 

I This is by far the ablest w^ork on Surgical Ana- 
I tomy that has come under our observation. We 
I know of no otlier work that would justify a stu- 
\ dent, in any degree, for neglect of nctual diss'^e- 
tion. A careful study of these pl.ates, and of the 
commentaries on them, would almost make an ana- 
tomist of a diligent student. And to one who has 
studied anatomy by dissection, this work is invalu- 
al)le as a perpetual remembrancer, in matters of 
knowledge that may slip from the memory. The 
practitioner can scarcely consider himself equipped 
for the duties of his profession without such a work 
as this, and this has no rival, in his library. In 
those sudden emergencies that so often arise, and 
which require the instantaneous command of minute 
anatomical knowledge, a work of tiiis kind keeps the 
detuilsof the dissecting-room perpetually fresh in the 
memory. We appeal to our readers, whether any 
one can justifiably undertake the practice of medi- 
\ cine who is not prepared to give all needful assist- 
[ ance, in all matters demanding immediate relief. 
1 AVe repeat that no medical library, however large, 
j can be complete without Maclise's Surgical Ana- 
tomy. The American edition is well entiiled to the 
! confidence of the profession, and should command, 
I among them, an extensive sale. The investment of 
; the amount of the cost of this work will prove to 
be a very profitable one, and if practitioners -would 
I qualify themselves thoroughly with such important 
knowledge as is contained in works of this kind, 
j there would be fe-wer of them sighing for emplo}-- 
; ment. The medical profession should spring towards 
. such an opportunity as is presented in this republica- 
tion, to encourage frequent repetitions of American 
j enterprise of this kind. — The Western Journal of 
t Medicine and Surgery. 



One of the greatest artistic triumphs of the age 
in Surgical Anatomy. — British American Medical 
Journal. 

Too much cannot be said in its praise ; indeed, 
we have not language to do it justice. — Ohio Medi- 
cal and Surgical Journal, 

The most admirable surgical atlas "we have seen. 
To the practitioner deprived of demonstrative dis- 
sections upon the human subject, it is an invaluable 
companion. — N. J. Medical Reporter. 

The most accurately engraved and beautifully 
colored plates we have ever seen in an American 
book — one of the I)est and cheapest surgical works 
ever published. — Buffalo Medical Journal. 

It is very rare that so elegantly printed, so well 
illustrated, and so useful a work, is offered at so 
moderate a price. — Charleston Medical Journal. 

Its plates can boast a superiority which places 
them almost beyond the reach of competition. — Medi- 
cal Examiner. 

Every practitioner, we think, should have a work 
of this kind within reach. — Southern Medical and 
Surgical Journal. 

No such lithographic illustrations of surgical re- 
gions have hitherto, we think, been given. — Boston 
Medical and Surgical Journal. 

As a surgical anatomist, Mr. Maclise has proba- 
bly no superior. — British and Foreign Medico-Chi- 
rurgical Revieio. 

Of great value to the student engaged in dissect- 
ing, and to the surgeon at a distance from the means 
of keeping up his anatomical knowledge. — Medical 
Times. 

The mechanical execution cannot be excelled. — 
Transylvania Medical Journal. 

A work which has no parallel in point of accu- 
racy and cheapness in the English language.— iV. Y. 
Journal of Medicine. 

To all engaged in the study or practice of their 
profession, such a work is almost indispensable. — 
Dublin Quarterly Medical Journal. 

No practitioner whose means will admit should 
fail to possess it. — Ratiking^s Abstract. 

Country practitioners will find these plates of im- 
mense value. — iY. Y. Medical Gazette. 

We are extremely gratified to announce to the 
profession the completion of this truly majnificent 
work, which, as a whole, certainly "stands unri- 



The very low price at whicli this work is furnished, and the beauty of its execution, 
require an extended sale to compensate the publisliers for the heavy expenses incurred. 



AND SCIENTIFIC PUBLICATIONS. 



23 



MULLER (PROFESSOR J.), M. D. 
PRINCIPLES OF PHYSICS AND METEOEOLOGY. Edited, with Addi- 

tions, by K. Eglesfeld Griffith, M. D. In one large and handsome octavo volume, extra 
cloth, with 550 wood-cuts, and two colored plates. 

The Physics of Muller is a work superb, complete. | tion to the scientific records of this country may be 
unique: the j^reatest want known tt) English Science | duly estimated by the fact that tiie cost of the origi- 
could not have been better supplied. Tlie work is I nal drawings and engravings alone has exceeded the 
of surpassing interest. The value of this contribu- | sum of £'2,000.— La;icc». 



MAYNE (JOHN), M. D., M. R.G.S., 

A DISPENSATORY AND THERAPEUTICAL REMEMBRANCER. Com- 
prising the entire lists of Materia Medlca, with every Practical Formula contained in the three 
British Pharmacopoeias. With relative Tables subjoined, illustrating, by upwards of six hundred 
and sixty examples, the Extemporaneous Forms and Combinations "suitable for the different 
Medicines. Edited, with the addition of the Formulae of the United States Pharmacopoeia, by 
R. Eglesfeld Griffith, M. D. In one 12mo. volume, extra cloth, of over 300 large pages. 



MATTEUCCI (CARLO). 
LECTURES ON THE PHYSICAL PHENOMENA OF LIVING BEINGS. 

Edited by Pereira. In one neat royal 12mo. volume, extra cloth, with cuts, 388 pages. 



MARKWICK (ALFRED). 
A GUIDE TO THE EXAMINATION OF THE URINE IN HEALTH 

AND DISEASE. Royal 12mo. (See M.anuals on Blood and TJrlne.) 



MEDLOCK (HENRY), AND F. SCHOEDLER. 

BOOK OF NATURE; or Elements of the Science of Physics, Astronomy, Chem- 
istry, Mineralogy, Geology, Botany, Zoology, and Physiology. (See Schoedler.) In one vol., 
largre IQmo. An admirable work for families and District Schools. 



NEILL (JOHN), M. D., 

Demonstrator of Anatomy in the University of Pennsylvania ; Surgeon to the Pennsylvania Hospital, &c.; 

and 
FRANCIS GURNEY SMITH, M.D., 
Professor of Institutes of Medicine in the Pennsylvania Medical College. 

AN ANALYTICAL COMPENDIUM OF THE VARIOUS BRANCHES 

OF MEDICAL SCIENCE ; for the Use and Examination of Students. Second edition, revised 
and improved. In one very large and handsomely printed royal IQmo. volume, of over one 
thousand pages, with three hundred and fifty illustrations on wood. Strongly bound in leather, 
with raised bands. (Extensively used by students.) 

PREFACE TO THE NEW EDITION. 

The speedy sale of a large impression of this work has afforded to the authors gratifying evidence 
of the correctness of the views which actuated them in its preparation. In meeting the demand 
for a second edition, they have therefore been desirous to render it more worthy of the favor with 
which it has been received. To accomplish this, they have spared neither time nor labor in embo- 
dying in it such discoveries and improvements as have been made since its first appearance, and 
such alterations as have been suggested by its practical use in the class and examination-room. 
Con>iderable modifications have thus been introduced throughout all the departments treated of in 
the volume, but more especially in the portion devoted to the " Practice of Medicine," which has 
been entirely rearranged and rewritten. The authors therefore again submit their work to the 
profession, with the hope that their efforts may tend, however humbly, to advance the great cause 
of medical education. 

Notwithstanding the increased size and improved execution of this work, the price has not been 
increased, and it is confidently presented as one of the cheapest volumes now before the profession. 

In the rapid course of lectures, where ■work for 
the students is heavy, and review necessary for an 
examination, a compend is not only valuable, but 
it is almost a sine qua non. The one before us is, 
in most of the divisions, the most unexceptionable 
of ail books of the kind that Ave know of. The 
newest and soundest doctrines and the latest im- 
provements and discoveries are explicitly, though 
{■oncisely, laid before the student. Of course it'is 
useless for us to recommend it to all last course 
students, but there is a class to whom we very 
sincerely commend this cheap book as worth its 
weisrht in silver — that class is the graduates in 
medicine of more than ten years' standing, who 
have not studied medicine since. They Avill perhaps 
find out from it that the science is not exactly now 
what it was when they left it off. — Th& Stethoscojpe 



Having made free use of this volume m our ex- 
aminations of pupils, we can speak from experi- 
ence in recommending it as an admirable compend 
for students, and as especially useful to preceptors 
who examine their pupils. It will save the teacher 
much labor by enabling him readily to recall all of 
tlie points upon vi^hich his pupils should be ex- 
amined. A work of tills sort should be in the hands 
of every one who takes pupils into his office with a 
view of examining them ; and this isunquestinnablj' 
the best of its class. liCt every practitioner who has 
pupils provide himself with it, and he will find the 
labor of refreshing his knowledge so much facilitated 
that he will be able to do justice to his pupils at very 
little cost of time or trouble to himself. — Transyl- 
vania Med. Journal. 



24 



BLANCHARD & LEA'S MEDICAL 



NELIGAN (J. MOORE), M. D., M. R. I. A., &,c. 
A PRACTICAL TREATISE ON DISEASES OF THE SKIN. In one 

neat royal ISmo. volume, of 334 pages. {Just Issued.) 

We know of no other treatise on tliis interesting I The greatest value of Dr. Neligan's treatise con- 
and important class of diseases that so iiappiiy meets | sists in the plain and thoroughly practical expo8iti<)n 
the urgent wants of the fjreat mass of physicians. — I he has given of tliis class of maladies. — Bril. and 
N. Y. Journal of Medicine. | For. Med.-Ckirurg. Review. 

PHILLIPS (BENJAMIN), F. R. S., &c. 

SCROFULA ; its Nature, its Prevalence, its Causes, and the Principles of its 
Treatment. In one volume, octavo, with a plate. 



PEREIRA (JONATHAN), M. D., F. R. S., AND L. S. 
THE ELEMENTS OF MATERIA MEDICA AND THERAPEUTICS. 

Third American edition, enlarged and improved by the author; including Notices of mo.<t of the 
Medicinal Substances in use in the civilized world, and forming an Encyclopaedia of Materia 
Medica. Edited by Joseph Carson, M. D., Professor of Materia Medica and Pharmacy in the 
University of Pennsylvania. In two very large octavo volumes, on small type, with about four 
hundred illustrations. 

Volume I. — Lately issued, containing the Inorganic Materia Medica, over 800 pages, with 145 

illustrations. 
Volume II. — Just ready, embracing the Organic Materia Medica, was left by the late author in 

nearly a complete state. The unfinished portion has been revised with his MSS., by Alfred S. 

Taylor and G. Owen Reese. Large 8vo. , 1250 pages, with plates and several hundred wood-cuts. 

The present edition of this favorite and standard work, will be found far superior to its predeces- 
sors. Besides very large additions and alterations which were made in the last London edition, 
the work has undergone a thorough revision on the part of the author expressly for this country ; 
and has farther received numerous additions from the editors. It is thus greatly inerea>ed in size, 
and most completely brought up to the present state of our knowledge on this important subject. 
A similar improvement will be found in its mechanical execution, being printed with new type on 
fine white paper, with a greatly extended series of illustrations, engraved in the highest style of art. 



The work, in its present shape, and so far as can 
be judged from the portion before the public, forms 
the most comprehensive and complete treatise on 
materia medica extant in the English language. — 
Dr. Pereira has been at great pains to introduce 
into his vimrk, not only all the information on the 
natural, chemical, and commercial history of medi- 
cines, which might be serviceable to the physician 
and surgeon, but v^rhatever might enable Jiis read- 
ers to understand thoroughly the mode of prepar- 



ing and manufacturing various articles employed 
either for preparing medicines, or for certain pur- 
poses in the arts connected with materia medica 
and the practice of medicine. The accounts of the 
physiological and therapeutic effects of remedies are 
given with great clearness and accuracy, and in a 
manner calculated to interest as well as instruct 
the reader. — The Edinburgk Medical and Surgical 
Journal. 



PAGET (JAMES), F. R. S., AND W. S. KIRKES. 
MANUAL OF PHYSIOLOGY. Second American edition. One vol., large 

r2rao. (See Kirkes.) 



PI RRIE (WILLIAM), F. R. S. E., 

Professor of Surgery in the University of Aberdeen. 

THE PHINCIPLES AND PRACTICE OF SURGERY. Edited by John 

Neill, JVI. D., Demonstrator of Anatomy in the University of Pennsylvania, Surgeon to the 
Pennsylvania Hospital, &c. In one very handsome octavo volume, of 780 pages, with 316 illus- 
trations. {J2ist Issued.) 



However vi'^ell it may be adapted for a text-book 
(and in tliis respect it may compete with the best of 
them) of this much our reading has convinced us, 
that as a systematic treatise, it is carefully and ably 
written, and can hardly fail to command a prominent 
position in the library of practitioners; though not 
complete in the fullest sense of the word, it never- 
theless furnishes the student and practitioner with 
as chaste and concise a work as exists in our l;m- 
guage. The additions to the volume by Dr. Neill, 
are judicious; and while they render it more com- 
plete, greatly enhance its practical value, as a Avork 
for practitioners and students. — iV. Y. Journal of 
Medicine. 

We know of no other surgical work of a reason- 
able size, Avherein there is so much theory and prac- 
tice, or where subjects are more soundly or clearly 
taught. — The stethoscope. 

There is scarcely a disease of the bone or soft 
parts, fracture, or dislocation, that is not illustrated 



by accurate wood-engravings. Then, again, every 
instrument employed by the surgeon is thus repre- 
sented. These engravings are not only correct, but 
really beautiful, showing the astonishing degree of 
perfection to u'hich the art of wrood-engraving has 
arrived. Prof. Pirrie, in the Avork before us, has 
elaborately discussed the principles of surgery, and 
a safe and elTectual practice predicated upon them. 
Perhaps no work upon this subject heretofore issued 
is so full upon the science of the art of surgery. — 
Nashville Journal of Medicine and Surgery. 

We have made ourselves more intimately acquaint- 
ed with its details, and can now pronounce it to be 
one of the best treatises on surgery in the English 
language. In conclusion, Ave very strongly recom- 
mend this excellent work, both to the practitioner 
and student. — Canada Med. Journal. 

Our impression is, that as a manual for students, 
Pirrie's is the best work extant. — Western Med. and 
Surg. Journal. 



AND SCIENTIFIC PUBLICATIONS. 



25 



RAMSBOTHAM (FRANCIS H.), M.D. 
THE PRINCIPLES AND PRACTICE OF OBSTETRIC MEDICINE AND 

SURGERY, in reference to the Process of Parturition. Sixth American, from the last London 
edition. Illustrated with one hundred and forty-eight Figures, on fifty-five Lithographic Plates. 
In one large and handsomely printed volume, imperial octavo, with 520 pages. 

In this edition, the plates have all been redraw^n, and the text carefully read and corrected. It 
is therefore presented as in every way worthy the favor with which it has so long been received. 

From Prof. Hodge ^ of the University of Pa. 
To the American public, it is most valuable, from its intrinsic undoubted excellence, and as being 
tlic best antliorized exponent of British Midwifery. Its circulation will, I trust, be extensive throughout 
our country. 



We recommend the student who desires to mas- 
ter this dirficult subject with the least possible 
trouble, to possess himself at once of a copy of this 
work. — American Journal of the Med. Sciences. 

It stands at the head of the long list of excellent 
obstetric works published in the last few years in 
Ixreat Britain, Ireland, and the Contincnt'of F.u- 
rope. We coiisider this book indispensable to tlie 
library of every physician engaged in the practice 
of midwileTy.— Southern Med. and Surg. Journal. 



When the whole profession is thus unanimous 
in placing such a work in the very first rank as 
regards the extent and correctness of all the details 
of'lhe theory and practice of so important a branch 
of learning, our commendatiim or condemnation 
would be 7)f little consequence; but regarding it 
as the most useful of all ^vorks of the kind, we 
think it but an act of justice to urge its claims 
upon the profession. — N. O. Med. Journal. 



RIGBY (EDWARD), M. D. 

Physician to the General Lying-in Hospital, &c. 

A SYSTEM OF MIDWIFERY. With Notes and Additional Illustrations. 

Second American Edition. One volume octavo, 422 pages. 

The repeated demands for this work, which has now for some time been out of print, have in- 
duced the publishers to prepare another edition. The reputation which it has acquired for the 
clearness of its views, especially as regards the physiological portion of obstetrical science, will 
secure for it the confidence of the profession. A copy of the first edition was placed in the hands 
ot'the late Professor Dewees, a few weeks before his death, and obtained from him the expression 
of his most favorable opinion. 



RICORD (PH.), M. D. 

HUNTER ON VENEREAL, with extensive Additions bj Ricord. (Now Ready.) 
See HuKTER. 



ROYLE (J. FORBES), M. D. 
MATERIA MEDICA AND THERAPEUTICS ; including the Preparations of 

the Pharmacopoeias of London, Edinburgh, Dublin, and of the United States. With many new 
medicines. Edited by Joseph Carson, M. D., Professor of Materia Medica and Pharmacy in 
the University of Pennsylvania. With uinetj^-eight illustrations. In one large octavo volume, 
of about seven hundred pages. 

This work is, indeed, a most valuable one, and I ductions on the other extreme, which are neces- 
wiil fill up an important vacancy that existed be- | sarily imperfect from their small extent. — British 
tween Dr. Pereira's most learned and complete I and Foreign Medical Review. 
system of Materia Medica, and the class of pro- j 



REESE (G. OWEN), M. D. 
ON THE ANALYSIS OF THE BLOOD AND URINE IN HEALTH AND 

DISEASE, and on the Treatment of Urinary Diseases. Royal 12mo., with plates. (See Blood 
and Urine., Maiiuals of.) 



RICORD (P.), M. D. 
A PRACTICAL TREATISE ON VENEREAL DISEASES. With a Thera- 

peutical Summary and Special Formulary. Translated by Sidney Doane, M. D. Fourth edition. 
One volume, octavo, 340 pases. 



SKEY (FREDERICK C), F. R. S., Sec. 
OPERATIVE SURGERY. In one very handsome octavo volume of over 650 

pages, with about one hundred wood-cuts. 



Its literary execution is superior to most surgical 
treatises. It abounds in excellent moral hints, and 
is replete with oris^inal surgical expedients and sug- 
gestions. — Buffalo Med. and Surg. Journal. 

With high talents, extensive practice, and a long 
experience, Mr. Skey is perhaps competent to the 
task of writing a complete work on operative sur- 
gery. — Charleston Med. Journal. 



We cannot withhold from this work our high com- 
mendation. Students and practitioners will find it an 
invaluable teacher and guide upon every topic con- 
nected with this department. — N. Y. Medical Ga- 
zette. 

A work of the very highest importance — a work 
by itself.— Loncfon Med. Gazette. 



26 



BLANCHARD & LEA'S MEDICAL 



SHARPEY (WILLIAM), M.D., QUAIN (JONES), M.D., AND 
QUAIN (RICHARD), F. R. S., &.c. 

HUMAN ANATOMY. Eevised, with Notes and Additions, by Joseph Leidy, 

M. D. Complete in two large octavo volumes, of about thirteen hundred pages. Beautifully 

illustrated with over five hundred engravings on wood. 

We have no hesitation in recommending this trea- 
tise on anatomy as the most complete on that sub- 
ject in the English language; and the only one, 
perhaps, in any language, wliich brings the state 
of knowledge forward to the most recent disco- 
veries. — The Edinburgh Med. and Surg. Journal. 



It is indeed a work calculated to make an era in 
anatomical study, by placing before the student 
every department of his science, with a view to 
the relative importance of each ; and so skilfully 
have the different parts been interwoven, that no 
one who makes this work the basis of his studies, 
will hereafter have any excuse for neglecting or 
undervaluing any important particulars connected 
with the structure of the human frame; and 
whether the bias of his mind lead him in a more 
especial manner to surgery, physic, or physiology, 
he will find liere a work at once so comprehensive 
an<i practical as to defend him from exclusiveness 
on the one hand, and pedantry on the other. — 
Monthly Journal and Retrospect of the Medical 
Sciences. 



Admirably calculated to fulfil the oljjcct for which 
it is intended. — Provincial Medical Journal. 

The most complete Treatise on Anatomy in the 
English language. — Edinburgh Medical Journal 

There is no work in the English language to he 
preferred to Dr. Quain's Elements of Anatomy. — 
London Journal of Medicine. 



SMITH (HENRY H.), M. D., AND HORNER (WILLIAM E.), M. D. 
AN ANATOMICAL ATLAS, illustrative of the Structure of the Human Body. 

In one volume, large imperial octavo, with about six hundred and fifty beautiful figures. 

late the student upon the completion of this Atlas, 
as it is the most convenient work of the kind that 
has yet appeared ; and we must add. the very beau- 
tiful manner in which it is "got up" is so creditable 
to the countr)- as to be flattering to our national 
pride. — American Medical Journal. 



These figures are well selected, and present a 
complete and accurate representation of that won- 
derful fabric, the human body. The plan of this 
Atlas, which renders it so peculiarly convenient 
for the student, and its superb artistical execution, 
liave been already pointed out. We must congratu- 



SARGENT (F. W.), M. D. 

ON BANDAama and other points of minor surgery. 

one handsome royal 12mo. volume of nearly 400 pages, with 128 vi-ood-cuts. 



In 



The very best manual of Minor Surgery we have 
seen ; an American volume, with nearly four hundred 
pages of good practical lessons, illustrated by about 
one hundred and thirt)^ wood-cuts. In these days 
of "trial," when a doctor's reputation hangs upon 
a clove hitch, or the roll of a bandage, it Avould be 
well, perhaps, to carry such a volume as Mr. Sar- 
gent's always in our coat-pocket, or, at all events, 
to listen attentively to his instructions at home. — 
Buffalo Med. Journal. 



We have carefull}' examined this work, and find it 
well executed and admirably adapted to the use o{ 
the student. Besides the subjects usually embraced 
in works on Minor Surgery, there is a short chapter 
on bathing, another on anassthetic agents, and an 
appendix of formulae. The author has given an ex- 
cellentwork on this subject, and his publishers have 
illustrated and printed it in most beautiful style. — 
Ike Charleston Medical Journal. 



STANLEY (EDWARD). 
A treatise on diseases of the bones. In one volume, octavo, 

extra cloth, 286 pages. 



SMITH (ROBERT WILLIAM). 
A TREATISE ON FRACTURES IN THE VICINITY OF JOINTS, AND 

ON DISLOCATIONS. One volume octavo, with 200 beautiful wood-cuts. 



SIMON (JOHN), F. R. S. 
GENERAL PATHOLOGY, as conducive to the Establishment of Rational 

Principles tor the Prevention and Cure of Disease. A Course of Lectures delivered at St. 
Thomas's Hospital during the summer Session of 1850. In one neat octavo volume. {Lately 
Issued.) 



His views are plainly and concisely stated, and m 
such an attractive manner, as to enchain the atten- 
tion of the reader, and should they be adopted by the 
profession at large, are calculated to produce im- 
portant changes in medicine. Physicians and stu- 
dents will obtain from its perusal, not only the latest 



discoveries in Pathology, but that which is even 
more valuable, a systematic outline for the prosecu- 
tion of their future studies and investigations. Alto- 
gether, we look upon it as one of the most satisfactory 
and rational treatises upon that branch now extant. 
— Medical Examiner . 



SMITH (TYLER W.), M. D., 

Lecturer on Obstetrics in the Hunterian School of Medicine. 

ON PARTURITION, AND THE PRINCIPLES AND PRACTICE 

OBSTETRICS. In one large duodecimo vo ume, of 400 pages. 



OF 



SIBSON (FRANCIS), M. D., 

Physician to St. Mary's Hospital. 

MEDICAL ANATOMY. Illustrating the Form, Structure, and Position of the 
Internal Organs in Health and Disease. In large imperial quarto, with splendid colored plates. 
To match -'Maclise's Surgical Anatomy." {Preparing.) 



AND SCIENTIFIC PUBLICATIONS. 



27 



SOLLY (SAMUEL), F. R. S. 
THE HUMAN BRAIN; its Structure, Physiology, and Diseases. With a 

Description of the Typical Forms of the Brain in the Animal Kingdom. From the Second and 
much enlarged London edition. In one octavo volume, with 120 wood-cuts. 



SCHOEDLER (FRIEDRICH), PH.D., 

Professor of the Natural Sciences at Worms, &c. 

THE BOOK OF NATURE; an Elementary Introduction to the Sciences of 

Physic8, Astronomy, Chemis^try, JMineralogry, Geology, Botany. Zoology, and Physiology. First 
American edition, ^vith a Glossary and other Additions and Improvements; from the second 
English edition. Translated fromihe sixth German e(iitit)n, by Henry ^Mkdlock, F. C. S., &c. 
In one thick volume, small octavo, of about seven hundied pages, with 679 illustrations on wood. 
Suitable for the higher Schools and private students. [Novj Reaehj.) 

Tiiis volume, as its title shows, covers nearly all I seen presents the reader with so Avide a range of ele- 
the sciences, and embodies a vast amount of informa- mentarj' knowledge, with so full illustrations, a: so 
tion for instruction. No other work that we have 1 cheap a rate. — Silliman's Journal^ Nov. 1853. 



TAYLOR (ALFRED S.), M . D., F. R. S., 

Lecturer on Medical Jurisprudence and Chemistry in Guy's Hospital. 

MEDICAL JURISPRUDENCE. Third American, from the fourth and improved 

English Edition. "With Notes and References to American Decisions, by Edward Hartshorne, 
M.l). In one large octavo volume, of about seven hundred pages. [N'ovj Ready .) 
In the preparation of the English edition, from which this has been printed, the author has found 
it necessary to revise the whole of the chapters, as well as to make numerous alterations and addi- 
t]OU<, together with references to many recent cases of importance. A Glossary has also been 
added fo7 the convenience of those whose studies have not been directed specially to this sbbject. 
The notes of the American editor embrace the additions formerly made by Dr. Griffith, who revised 
tiie work on its first appearance in this country, together with such new matter as his experience 
nnd the progress of the science have shown to be advisable. The work may therefore be regarded 
as fully on a level with the most recent discoveries, and worthy of the reputation which it has ac- 
quired as a coniplete and compendious guide for the physician and lawyer. 

So well is this work known to the members bo'h ! never before published ; in the supervision of this. 
of the medical and legal professions, and so highly ] the third American, one of the last labors of the la- 
is it appreciated by them, that it cannot be necessary mented Dr. Griffith, we find a goodly number of notes 
l~oi- us to say a word in its commendation ; its having and additions. The publishers deserve the support 
already reached a fourth edition_being the best pes- of the profession for the publication of a work of 

such sterling merit. — Charleston Medical Journal 
and Revieio. 

It is not excess of praise to say that the volume 
before us is the very best treatise extant on Medical 
Jurisprudence. In saying this, we do not wish to 
be understood as detracting from the merits of the 
excellent works of Beck, Ryan, Traill, Guy, and 
others; but in interest and value we think it must 

--, - be cimceded that Taylor is superior to anything that 

nt on the subject I has preceded it. The author is already \vell known 
to the profession by his valuable treatise on Poisons ; 
and the present volume will add materially to his 
high reputation for accurate and extensive knoM'- 
ledge and discriminating judgment. Dr Griffith has, 
in his notes, added many matters of interest witn 
reference to American Statute Law, &c., so that the 
work is brought completely up to the wants of the 
physician and lawyer at the present day. — N. W. 
Medical and Surgical Journal, 



fiible testnnony in its favor. The author has ob- 
viously subjected the entire work to a very careful 
revision. We find scattered through it numerous 
additions and alterations, some of them of consider- 
able importance; and reference is made to a large 
number of cases which have occurred since the date 
of the last publication. — British and Foreign Med.- 
Chirurg. Review. 



'enerallv acknow- 



Tliis work of Dr. Taylor's is 
lodged to be one of the ablest ext 
of medical jurisprudence. It is certainly one of the 
most attractive books that we have met with; sup- 
plying so much both to interest and instruct, that 
we do not hesitate to affirm that after having once 
commenced its perusal, few could be prevailed upon 
to desist before completing it. In the last London 
edition, all the newly observed and accurately re- 
corded facts have been inserted, including much that 
is recent of Chemical, Microscopical, and Patholo- 
gical research, besides papers on numerous subjects 

* BY THE SAME AUTHOR. 

ON POISONS, IN RELATION TO MEDICAL JURISPRUDENCE AND 

MEDICINE. Edited, with Notes and Additions, by R. E. Griffith, M. D. In one large octavo 
volume, of 6SS pages. 

One of the most practical and trustworthy works 
on Poisons in our language. — Western Journal of 
Medicine. 



The most elaborate work on the subject that our 
literature possesses. — British and Foreign Medico- 
Chirurgical Review. 

It contains a vast body of facts, ^vhich embrace 
all that is important in toxicology, all that is 
necessary to the guidance of the medical jurist, and 



It is, so far as our knoAvledge extends, incompa- 
rably the best upon the subject; in the highest de- 
gree creditable to the author, entirely trustworthy. 



all that can be desired by the lawyer. — Medico- | and indispensable to the student and practitioner. 
Chirurgical Review. \ N. Y. Annalist. 



THOMSON (A. T.), M . D., F. R. S., Sec, 
DOMESTIC MANxVGEMENT OF THE SICK ROOM, necessary in aid of 

Medical Treatment for the Cure of Diseases. Edited by R. E. Griffith, M. D. In one large 
royal ]2mo. volume, with wood-cuts, 360 pages. 



TOMES (JOHN), F. R. S. 
A MANUAL OF. DENTAL PRACTICE. Illustrate] by numerous engravings 

on wood. In one handsome volume. (Freparing.) 



28 



BLANCHARD & LEA'S MEDICAL 



TODD (R. B.), M. D. 



With 
PartlV 



,, .,.. ^., AND BOWMAN (WILLIAM), F. R. S. 
PHYSIOLOGICAL ANATOMY AND PHYSIOLOGY OF MAN. 

numerous handsome wood-cuts. Parts I, 11, and III, in one octavo volume, 552 pa^-es. 
will complete the work. ° 

The disting-uishing peculiaritj- of this work is, that the authors investigate for themselves every 
fact asserted ; and it is the immense labor consequent upon the vast number of observations re- 
quisite to carry out this plan, which has so long delaved the appearance of its completion. Part 
IV, wilh numerous ongmal illustrations, is now appearing in the Medical Xews and Library for 
1853. Those who have subscribed since the appearance of the preceding portion of the work can 
have the three parts by mail, on remittance of $2 50 to the publishers. 



TRANSACTIONS OF THE AMERICAN MEDICAL ASSOCIATION. 
VOLUME YI, for 1853^ large 8vo., of 870 pages, with numerous colored plates 

and wood-cuts. 



Also to be had. a few sets of the Transactions from 1848 to 1853, in six large octavo volume* 
These volumes are published by and sold on account of the Association. ' ' 



price §25. 



WATSON (THOMAS), M.D., &,c. 
LECTURES ON THE PRINCIPLES AND PRACTICE OF PHYSIC. 

Third American, from the last London edition. Revised, with Additions, by D. Francis Condie, 
M. D , author of a •• Treatise on the Diseases of Children," &:c. In one octavo volume, of neariv 
eleven hundred large pages, strongly bound with raised bands. 

Confessedly one of the very best works on the 
principles and practice of physic in the English or 
any other lang^uage. — Med. Examiner. 

Asa text-book it has no equal ; as a compendium 
of pathology and practice no superior. — New York 
Annalist. 

We know of no work better calculated for being 
placed in the hands of the student, and for a text- 
book; on every important point the author seems 
to have posted up his knowledge to the day. — 
Amer. Med. Journal. 

One of the most practically useful books th:it 
ever was presented to the student. — N. Y. Med. 
Journal. 



To say that it is the verj- best work on the sub- ' 
ject now extant, is but to echo the sentiment of the ' 
medical press throughout the country. — N. O. \ 
Medical Journal. j 

Of the text-books recently republished Watson is '' 
very justly the principal favorite. — Holmes^s Rep. I 
to Nat. Med. Assoc. \ 

By universal consent the work ranks among the 
very best text-books in our language. — Illinois and 
Indiana Med. Journal. \ 

Regarded on all hands as one of the very best, if | 
not the very best, systematic treatise on practical j 
medicine extant. — St. Louis Med. Journal. ■ 



V/ALSHE (W. H.), M. D., 

Professor of the Principles and Practice of Medicine in University College, London. 

DISEASES OF THE HEART, LUNGS, AND APPENDAGES; their 

Symptoms and Treatment. In one handsome volume, large royal 12mo., 512 pages. 



"We consider this as the ablest -work in the En- 
glish language, on the subject of Avhich it treats; 
the author being the first stethoscopist of the day. 
— Charleston Medical Journal. 

The examination we have given the above work, 
convinces us that it is a complete system or treatise 
upon the great speciality of Physical Diagnosis. To 
give the reader a more perfect idea of what it con- 



tains, we should be glad to copy the whole table of 
contents and make some extracts from its pages, but 
our limits forbid. We have no hesitation in recom- 
mending the work as one of the most complete on 
this subject in the English language; and yet it is 
not so voluminous as to be objectionable on this ac- 
count, to any practitioner, however pressing his 
engagements.— OAio Medical and Surgical Journal. 



WHAT TO OBSERVE 
AT THE BEDSIDE AND AFTER DEATH, IN MEDICAL CASES. 

Published under the authority of the London Society for Medical Observation. In one very 

handsome volume, ro\al 12mo , extra cloth {Just Issued.) 

Did not the perusal of the work justify the high ] correct diagnosis, it Avill prove exceedingly valua- 
"^ "^^ ' ' ■' ble. The great difficulty with beginners, "who have 
not been under the immediate training of an expe- 
rienced physician, is continually found to be in the 
appreciation of the true condition of the organs and 
tissues. Let such provide themselves with this 
work and study it thoroughly, and thev will find 
much of the difficulty removed. — Southern Medical 
and Surgical Journal. 

This is truly a very capital book. The whole 
medical world will reap advantages from its publi- 
cation. The medical journals will soon show its 
influence on the character of the •' Reports of Cases" ' 
which they publish. Drs. Ballard and Walshe have 
given to the world, through a small but useful 
medical organization, a cheap but invaluable book. 
We do advise every reader of this notice to buy i: 
and use it. Unless he is so vain as to imagine him- 
self superior to the ordinary human capacity, he will 
in six months see its inestimable advantages. — 
Stethoscope. 



opinion we have of it, the names of Dr. Walshe, the 
origmator, and of Dr. Ballard, as the editor of the 
volume, would almost of itself have satisfied us that 
it abounds in minute clinical accuracy. We need 
not say that the execution of the whole reflects the 
highest credit not only upon the gentlemen men- 
tioned, but upon all those engaged upon its produc- 
tion. In conclusion, \ve are'convinced that the 
possession of tlie work -will be almost necessary to 
every member of the profession — that it will be 
found indispensable to the practical physician, the 
pathologist, the medical jurist, and above all to the 
medical student. — Londoii Medical Times. 

We hail the appearance of this book as the grand 
desideratum. — Charleston Medical Journal. 

This little work, if carefully read by even old 
practitioners, cannot fail to be productive of much 
good ; as a guide to the younger members of the pro- 
fession in directing their attention specially to the 
best mode of investigating cases so as to arrive at 



AND SCIENTIFIC PUBLICATIONS. 



29 



WILSON (ERASMUS), M.D., 

Lecturer on Anatomy, London. 



F. R. S. 



A SYSTEi\r OF HUMAN ANATOMY, General and Special. Fourth Ameri- 
can, from the last English edition. Edited by Paul B. GonnARD, A. M., M D. Willi two hun- 
dred and lifly illustrations. Beautifully printed, in one large octavo volume, of nearly six hun- 
dred pages. 

It offers to tlie student all the assistance that c:in 
be expected from such a work. — Medical Examiner. 

Tlie most complete and convenient manunl for the 
student we possess. — American Journal of Medical 
Science. 

In every respect, this work as an anatomical 
ijuitle for the student and practitioner, merits our 
warmest and most decided praise. — London Medical 
Gazette. 



In many, if not all the Colleges of the Union, it 
has become a standard text-book. This, of itself, 
is sufficiently expressive of its value. A work very 
desirable to tlie student; one, the possession of 
\vhich will greatly facilitate his progress in the 
study of Practical Anatomy. — New York Journal of 
Medicine. 

Its author ranks with the highest on Anatomy. — 
Southern Medical and Surgical Journal. 



BY THE SAME AUTHOR. 

THE DISSECTOR; or, Practical and Surgical Anatomy. Modified and Re- 
arranged, by Paul Beck Goddard, M. D. A new edition, with Revisions and Additions. I.n 
one large and handsome volume, royal i2mo., with one hundred and fifteen illustrations. 

In passing this work again through the press, the editor has made such additions and improve- 
ments as tlie advance of anatomical knowledge has rendered necessary to maintain the work in the 
high reputation which it has acquired in the schools oi'the United Staie>. as a complete and laillifn! 
guide to the student of practical anatomy. A number of new illustrations have been added, espe- 
cially in the portion relating to the complicated anatomy of Hernia. In meclianical execution the 
work will be found superior to former editions. 



BY THE SABIE AUTHOR. 

ON DISEASES OF THE SKIN. Third American, from the third London 

edition. In one neat octavo volume, of about five hundred pages, extra cloth. {Just Issued.) 

Also, to be had done up with fifteen beautiful steel plates, of which eight are exquisitely colored ; 
representing the Normal and Pathological Anatomy of the Skin, together with accurately colored 
delineations of more than sixty varieties of disease, most of them the size of nature. The Plates 
are also for sale separate, done up in boards. 

The increa^ed size of this edition is sufficient evidence that the author has not been content 
with a mere republication, but has endeavored to maintain the high character of his work as the 
standard text-book on this interesting and difficult class of diseases. He has thus introduced such 
new matter as the experience of the last three or four years has suggested, and has made such 
alterations as the progress of scientific investigation has rendered expedient. The illustrations have 
also been materially augmented, the number of plates being increased from eight to sixteen. 

this range of diseases, engage the practitioner's 
attention, and possesses the high quality — unknown, 
we believe, to every older manual — of being on a 
level with science-s high-water mark ; a sound book 
of practice. — London Med. Ti77ies. 

Of these plates it is impossible to speak too highly. 
The representations of the various forms of cuta- 
neous disease are singularly accurate, and the color- 
ing exceeds almost anything we have met wilh in 
point of delicacy and finish. — British and Foreign 
Medical Review. 



The "Diseases of the Skin," by Mr. Erasmus 
Wilson, may now be regarded as the standard work 
in that department of medical literature. The 
plates by which this edition is accompanied leave 
nothing to be desired, so far as excellence of delinea- 
tion and perfect accuracy of illustration are con- 
cerned. — Medico-C hirurgical Review. 

As a practical guide to the classification, diag- 
nosis, and treatment of the diseases of the skin, the 
book IS complete. We know nothing, considered 
in this aspect, better in our language; it is a safe 
authority on all the ordinary matters which, in 



BY THE SAME AUTHOR. 

ON CONSTITUTIONAL AND HEREDITARY SYPHILIS, AND ON 

SYPHILITIC ERUPTIONS. In one small octavo volume, beautifully printed, with four exqui- 
site colored plates, presenting more than thirty varieties of syphilitic eruptions. 



This, in many respects, is a remarkable Avork, pre- 
senting views of theory and prmciples of practice 
which, if true, must change completely the existing 
state of professional opinion. — New York Journal of 
Medicine. 

Dr. Wilson's views on the general subject of 
Syphilis appear to us in the main sound and judi- 
cious, and we commend the book as an excellent 
monograph on the subject. Dr. Wilson has pre- 
sented us a very faithful and lucid description of 



Syphilis and has cleared up man^^ obscure points in 
coimection Avith its transmissihility, pathology auil 
sequelae. His facts and references will, we are satis- 
fied, be received as decisive, in regard to many 
questiones vexatae. They appear to us entitled to 
notice at some length. We have perhaps been som»- 
wiiat prodigal of space in our abstract of this book. 
But It is certainly a very good resume of received 
opinions on Syphilis, and presents, io many, original 
and striking views on the subject. — Med. Examiner. 



WHITEHEAD (JAMES), F. R. C. S., &c. 

THE CxiUSES AND TREATMENT OF ABORTION AND STERILITY; 

being the Result of an Extended Practical Inquiry into the Physiological and Morbid Conditions 
of the Uterus. In one volume, octavo, 368 pages. 



30 BLANCHARD & LEA'S MEDICAL 

WILDE (W. R.), 

Surgeon to St. Mark's Oplithalrnic and Aural Hospital, Dublin. 

AURAL SURGP]RY, AND THE NATURE AND TREATMENT OF DIS- 
EASES OF THE EAR. In one handsome octavo volume, with illustrations. {Now Ready.) 
So little is generally known in this country concerning the causes, symptoms, and treatment of 
aural afiections, that a praclical and scientific work on that subject, from a practitioner of Mr. 
Wilde's great experience, cannot fail to be productive of much benefit, by attracting attention 
to this obscure class of disea>es, which too frequently escape attention until past relief. The im- 
mense number of cases which have come under ]\Jr. Wilde's observation for many years, have 
aribrded him opportunities rarely enjoyed for investigating this branch of medical science, and hi* 
work may therefore be regarded as of the highest authority. ^ 



WEST (CHARLES), M. D., 

Senior Physician to the Royal Infirmary for Children, &.C. 

LECTURES OX THE DISEASES OF INFANCY AND CHILDHOOD. 

In one volume, octavo, of four hundred and fifty pages. 

The Lectures of Dr. West, originally published in | Every portion of these lectures is marked by a ge 



the London Medical Gazette, form a most valuable 
addition to this branch of practical inedieine. For 
many years physician to the Children's Infirmary, 
liis opportunities for observing their diseases have 
l)een most extensive, no less th:m 14,000 children 
Iiaving been brought under his notice during the past 
nine vears. These have evidently been studied with 
^rent'care. and the result has been the production of 



neral accuracy of description, and by the soundness 
of the views set forth in relation to the pathology 
and therapeutics of the several maladies treated of. 
The lectures on the diseases of the respiratory ap- 
paratus, about one-third of the \vhole number, are 
particularly excellent, forming one of tiie fullest 
and most able accounts of these affections, as ther 
present themselves during infancy and childhood, 



the very best work in our language, so far as it goes, j in the English language. The history of the seve- 
on the 'diseases of this class^of our patients. The i ral forms of phthisis during these periods of exist- 
sympcomatolo?y and pathology of their diseases are | ence, with their management, will be read by all 
especially exhibited most cleiuly ; and we are con- i with deep interest. — tlie Atnerican Journal of the 
vinced that no one can read with care these lectures { Medical Sciences. 
without deriving from them instruction of the most i 
important kind.— Charleston Med. Journal. I 



WILLIAMS (C. J. B.', M. D., F. R.S., 

Professor of Clinical Medicine in L'niversity College, London, &c. 

PRINCIPLES OF MEDICINE ; comprising General Pathology and Therapeu- 
tics, and a brief general view of Etiology, Nosology, Semeiology, Diagnosis, Prognosis, and 
Hygienics. Edited, with Additions, by Meredith Ci^Y^iER. M. D. Fourth American, from the 
last\nd enlarged London edition. In one octavo volume, of nearly five hundred pages. 2\''opj 
Ready. This new edition has been materially enlarged and brought up by the editor. 
It possesses the strongest claims to the attention of the medical student and practitioner, from 

the admirable manner in which the various inquiries in the diflerent branches of pathology are 

investio-ated, combined, and generalized by an experienced practical physician, and directly applied 

to the fnvestigation and treatment of disease.— Editor's Preface. 

The best exposition in our language, or, we be- I Few books have proved more usefnl, or met with 

lieve. in any language, of rational ra'edicine, in its | a more ready sale than this, and no practitioner 

present improved and' rapidly improving state. — I should regard his library as complete without it. 

British and Foreign Medico-Chirurg. Review. \ —Ohio Med. and Surg. Journal. 

BY THE SAME AtJTHOR. 

A PRACTICAL TREATISE ON DISEASES OF THE RESPIRATORY 

ORGANS; including Diseases of the Larynx, Trachea, Lungs, and Pleurae. With numerons 
Addiiions and XotesTby M. Clymer. ]\L t). With wood-cuts. In one octavo volume, pp. 50S. 



YOUATT (WILLIAM), V. S. 
THE HORSE. xV new edition, with numerous illustrations; together with a 

o-eneral history of the Horse; a Dissertation on the American Trotting Horse ; how Trained and 
Jockeved; an'Account of his Remarkable Performances ; and an Essay on the Ass and theMuie. 
Bv J.' !S. Skinnkr, formerly Assistant Postmaster-General, and Editor of the Turf Register. 
Oiie large octavo volume. 

BY THE SAME AUTHOR. 

THE DOG-. Edited by E. J. Lewis, M. D. With numerous and beautiful 

illustrations. In one very handsome vokuue. crown Svo., crimson cloth, gilt. 



ILLUSTRATED MEDICAL CATALOGUE. 

BLANCHARD & LEA have now ready a Catalogue of their Medical and Surgical Publi- 
cations, containing descriptions of the works, with. Notices of the Press, and specimens of 
the illustrations, making a pamphlet of forty-eight large octavo pages. It has been prepared 
with great care, and without regard to expense, forming one of the most beautiful specimens 
of typographical execution as yet issued in this country. Copies will be sent by mail, and 
the postage paid, on application to the Publishers, by inclosing a three cent postage stamp. 



AND SCIENTIFIC PUBLICATIONS. 



31 



B. & L. subjoin a condensed list of their publications in general and educational 
literature, of which more detailed catalogues will be furnished on application. 

HISTORY AND BIOGRAPHY. 



BROWNING'S HISTORY OF THE HUGUE 
NO rS. 1 vol. Svo. 

CAMPBELLS (LORD) LIVES OF THE LORD 
CHA.NCELLORS OF ENGLAND, from ilie earl- 
iest rimes to ihe Reiga of George IV. In seven 
handsome crown octavo volumes, extra cloth or 
halfmorocco. 

CAMPBELLS (LORD) LIVES OF THE CHIEF 
JUSTICES OF ENGLAND, from the Norman 
Conquest. In two lianiisome crown octavo vols., 
to match the " Chancellors."' 

DIXON'S LIFE OF WILLIAM PENN. A new 
vi'ork. 1 vol. royal l*2mo , exira cloth. 

GRAHAVIE'S CULONIAL HISTORY OF THE 
UNITED STAPES. 2 vols. Svo. A new edition. 

GUIZOT'S LIKE OF CROMWELL. (Preparing.) 

HERVEY-S xMEMOIRS OF GEORGE II. 2 vols, 
roval 12mo.. extra cloth. 

INGERSOLL'S HISTORY OF THE LATE WAR. 
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KENNEDY'S LIFE OF WILLIAM WIRT. 2d 
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Same work, library edition. 2 vols. Svo. 

KAVANAGHS WOMAN IN FRANCE IN THE 
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LOUIS BLANC'S FRENCH REVOLUTION. 1 vol 

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MARSH (MRS.) ROMANTIC HISTORY OF THE 

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NiEbUHRS ANCIENT HIS TORY. By Leonhakd 
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j STEINMETZS HISTORY OF THE JESUITS. 
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ACTON (MRS.) MODERN COOKERY. Edited by 

Mrs. S J Hale. 1 handsome volume, royal J2mo., 

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ADDISON ON CONTRACTS, and on Parties to 

Actions, ex contractu. 1 large octavo volume, law 

sheep. 
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volume sold separate. 
Same work, common edition, in paper, 10 parts. Any 

volume sold separate. 
Same work, in 4 large vols., good paper, fancy cloth. 
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EXPLORING EXPEDITION, NARRATIVE OF 

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